Rupture of the Extensor Digitorum Tendon of the Fifth Toe Linked to Press-Tack Needle Acupuncture During Sports Activity, Case Report Reveals

A rare case of extensor digitorum tendon rupture in the fifth toe has been attributed to the use of press-tack needle acupuncture during a sports activity, according to a case report published in Cureus. The incident, documented in a 2023 study, highlights potential risks associated with acupuncture techniques in physically active individuals.

Understanding the Extensor Digitorum Tendon and Its Role in Foot Function

The extensor digitorum longus muscle, which extends the toes, is controlled by the extensor digitorum tendon. This tendon is critical for maintaining balance and gait, particularly during high-impact activities. Ruptures are typically associated with trauma, such as falls or direct blows, but the case report describes an atypical cause: acupuncture.

According to the American College of Sports Medicine, tendon injuries in the foot often require surgical intervention or prolonged rehabilitation. The report notes that the patient, a 34-year-old athlete, experienced sudden pain and loss of function in the fifth toe after a session of press-tack needle acupuncture, a technique involving small, semi-permanent needles applied to acupoints.

Press-Tack Needle Acupuncture: Technique and Potential Risks

Press-tack needles, also known as “tei shu” needles, are commonly used in traditional Chinese medicine for prolonged stimulation of acupoints. Unlike conventional acupuncture, which involves quick insertion and removal, press-tack needles are left in place for hours or days. While generally considered safe, the case report raises concerns about their use in areas with thin soft tissue coverage, such as the toes.

A 2021 review in Acupuncture in Medicine noted that complications from acupuncture, including tendon or nerve injury, are rare but not unheard of. The study emphasized the importance of proper needle placement and patient positioning, particularly in areas with complex anatomy.

Case Details and Clinical Implications

The patient in the case report underwent surgery to repair the ruptured tendon, followed by a six-month rehabilitation program. The study’s authors caution that while acupuncture is widely used for pain management and recovery, practitioners should exercise caution when targeting areas near tendons or nerves. They also recommend thorough patient education on recognizing signs of complications, such as severe pain or impaired mobility.

Dr. Sarah Lin, a dermatologist and acupuncture specialist at the Mayo Clinic, explained that “the risk of tendon injury from acupuncture is extremely low, but it underscores the need for personalized treatment plans, especially for athletes who may have unique anatomical considerations.”

What This Means for Athletes and Acupuncturists

For athletes, the case serves as a reminder to communicate openly with healthcare providers about all interventions, including alternative therapies. For acupuncturists, it reinforces the importance of anatomical knowledge and risk mitigation strategies. The American Academy of Medical Acupuncture recommends that practitioners avoid placing needles in areas with limited subcutaneous tissue, such as the toes, unless absolutely necessary.

Further research is needed to determine the frequency of such incidents. However, the case report provides a valuable cautionary example of how even minimally invasive procedures can lead to unexpected complications.

Key Takeaways

• Rupture of the extensor digitorum tendon in the fifth toe is a rare complication linked to press-tack needle acupuncture during sports activity.
• Press-tack needles, while generally safe, require careful placement to avoid injury to tendons or nerves.
• Patients and practitioners should be aware of potential risks and prioritize communication and anatomical awareness.