Partial Tear of the Flexor Hallucis Longus at the Knot of Henry: Presentation of Three Cases

1997 ◽  
Vol 18 (4) ◽  
pp. 243-246 ◽  
Author(s):  
Peter M. Boruta ◽  
Gilbert D. Beauperthuy
Keyword(s):  
Surgical Treatment ◽  
Metatarsophalangeal Joint ◽  
Flexor Hallucis Longus ◽  
Great Toe ◽  
Flexor Digitorum Longus ◽  
Posterior Aspect ◽  
Stenosing Tenosynovitis ◽  
Longitudinal Split ◽  
Flexor Digitorum

The flexor hallucis longus (FHL) tendon is susceptible to injury along its entire course from the posterior aspect of the ankle to its insertion into the base of the distal phalanx of the great toe. Various lacerations, ruptures, longitudinal splits, and stenosing tenosynovitis have been noted. This report documents three cases of longitudinal split of the FHL at the knot of Henry. The diagnosis of this entity is based solely on history and physical examination. Patients with this problem have experienced either an acute or chronic repetitive hyperextension of the hallux metatarsophalangeal joint. They complain of pain with prolonged walking and running and have tenderness with palpation of the knot of Henry (the anatomical crossover between the FHL and the flexor digitorum longus) about one thumb-breadth lateral to the tuberosity of the navicular. Noninvasive imaging studies, including ultrasound and magnetic resonance imaging, are not helpful in establishing this diagnosis. Surgical treatment includes release of the knot of Henry, debridement and repair of the longitudinal split in the FHL, and excision of the interconnecting tendon between the FHL and the flexor digitorum longus. All three patients presented in this report have obtained long-term satisfactory relief of their symptoms with surgical treatment.

scholarly journals Flexor Digitorum Accessorius Longus: Importance of Posterior Ankle Endoscopy

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Jorge Pablo Batista ◽  
Jorge Javier del Vecchio ◽  
Pau Golanó ◽  
Jordi Vega
Keyword(s):  
Anatomical Variation ◽  
Osteochondral Lesion ◽  
Posterior Region ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Stenosing Tenosynovitis ◽  
Posterior Ankle Impingement ◽  
Flexor Digitorum Accessorius Longus ◽  
Flexor Digitorum ◽  
Type Of Injury

Endoscopy for the posterior region of the ankle through two portals is becoming more widespread for the treatment of a large number of conditions which used to be treated with open surgery years ago. The tendon of theflexor hallucis longus(FHL) travels along an osteofibrous tunnel between the posterolateral and posteromedial tubercles of the talus. Chronic inflammation of this tendon may lead to painful stenosing tenosynovitis. The aim of this report is to describe two cases depicting an accessory tendon which is an anatomical variation of theflexor hallucis longusin patients with posterior friction syndrome due to posterior ankle impingement and associated with a posteromedial osteochondral lesion of the talus. The anatomical variation (FDAL) described was a finding during an endoscopy of the posterior region of the ankle, and we have spared it by sectioning the superior flexor retinaculum only. The accessory flexor digitorum longus is an anatomical variation and should be taken into account when performing an arthroscopy of the posterior region of the ankle. We recommend this treatment on this type of injury although we admit this does not make a definite conclusion.

Accessory museulus soleus

1926 ◽  
Vol 22 (5-6) ◽  
pp. 511-513
Author(s):  
V. N. Ternovsky ◽  
M. Sadykova
Keyword(s):  
Lower Limb ◽  
Lower Leg ◽  
Flexor Hallucis Longus ◽  
Posterior Surface ◽  
Flexor Digitorum Longus ◽  
Accessory Muscle ◽  
Peroneus Brevis ◽  
The Right ◽  
Flexor Digitorum

Dissecting the muscles of the right lower limb of an unknown corpse, we found an accessory muscle on the posterior surface of the lower leg. This muscle (see Fig.) Was bordered behind in. soleus and with the tendon m. plantaris, in front - with in. flexor hallucis longus, medially - c m. flexor digitorum longus and laterally - c m. peroneus brevis.

Recurrent inhibition to and from motoneurons innervating the flexor digitorum and flexor hallucis longus muscles of the cat

1990 ◽  
Vol 63 (3) ◽  
pp. 395-403 ◽  
Author(s):  
T. M. Hamm
Keyword(s):  
Tibialis Anterior ◽  
Recurrent Inhibition ◽  
Medial Gastrocnemius ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Lateral Gastrocnemius ◽  
Hindlimb Muscles ◽  
Inhibitory Postsynaptic Potentials ◽  
Flexor Digitorum ◽  
Stimulation Of

1. Recurrent inhibitory postsynaptic potentials (IPSPs) to and from motoneurons innervating the flexor digitorum longus (FDL) and flexor hallucis longus (FHL) muscles of the cat were investigated to determine whether recurrent inhibitory projections involving these motoneurons are similar--as would be consistent with the Ia and anatomic synergism of FDL and FHL--or are dissimilar, as are the activities of these muscles during locomotion (O'Donovan et al. 1982). 2. Composite recurrent IPSPs were recorded in several species of motoneurons innervating hindlimb muscles in response to stimulation of a number of muscle nerves in cats allowed to become unanesthetized after ischemic decapitation. 3. No recurrent IPSPs from stimulation of the FDL nerve were observed in motoneurons innervating FDL, FHL, lateral gastrocnemius-soleus (LG-S), medial gastrocnemius (MG), plantaris (Pl), tibialis anterior (TA), or extensor digitorum longus (EDL). 4. The recurrent IPSPs produced by stimulation of FHL were larger and found more frequently in LG-S than in FDL motoneurons. Recurrent inhibition from FHL was also greater in Pl than in FDL motoneurons. 5. The recurrent IPSPs produced by stimulation of LG-S, PL, and MG were larger in FHL than in FDL motoneurons, and those from LG-S and MG were found more frequently in FHL than in FDL motoneurons. 6. Stimulation of the TA nerve produces recurrent IPSPs in FDL but not in FHL motoneurons. A few FDL and FHL cells (6 of 23 and 9 of 34, respectively) received small (less than 0.5 mV) recurrent IPSPs from stimulation of the EDL nerve.(ABSTRACT TRUNCATED AT 250 WORDS)

Communications between the tendons of flexor hallucis longus and flexor digitorum longus: a cadaveric study

2019 ◽  
Vol 41 (12) ◽  
pp. 1411-1419
Author(s):  
T. K. Vasudha ◽  
P. C. Vani ◽  
G. Sankaranarayanan ◽  
S. S. S. N. Rajasekhar ◽  
V. Dinesh Kumar
Keyword(s):  
Cadaveric Study ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Flexor Digitorum

scholarly journals Safe Zone for the Plantar Portal

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Shingo Maeda ◽  
Takaaki Hirano ◽  
Akiyama Yui ◽  
Hiroyuki Mitsui ◽  
Hisateru Niki
Keyword(s):  
Endoscopic Surgery ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Peroneus Longus Tendon ◽  
Medial Plantar Nerve ◽  
Longus Tendon ◽  
Peroneus Longus ◽  
Lateral Plantar Nerve ◽  
Medial Side ◽  
Flexor Digitorum

Category: Arthroscopy Introduction/Purpose: Open surgery of the sole of the foot requires an extensive amount of soft tissue to be dissected. In recent years, various types of endoscopic surgery for the sole of the foot have been reported, making it possible to dynamically evaluate and treat plantar lesions with a small skin incision and minimal dissection. However, there have also been reports of complications involving plantar nerve injury. A good knowledge of the plantar nerve anatomy is crucial for safe endoscopic surgery of the sole. We aimed to anatomically dissect the soles of cadaveric feet to investigate the safe zones for plantar portals. Methods: We studied 36 feet of 24 cadavers. The soft tissue of the sole was dissected, and the relationships between the plantar nerve and flexor digitorum longus tendon, flexor hallucis longus tendon and peroneus longus tendon were studied. The plantar nerve course was digitally imaged and uploaded into Image J software to determine the nerve position. The back of the calcaneus, the medial side of the base of M (Metatarsal) 1, the medial side of the head of M1, the lateral side of the head of M5, and the proximal tip of M5 were plotted and defined as A, B, C, D, and E respectively on Image J. The nerve courses were plotted on AB, BE, and CD, and the percentage at which they were positioned on the line segment was calculated. Next, the bifurcation positions of each nerve were plotted and measured to the defined line segments. Results: No major differences were noted in the course of the medial plantar nerve and lateral plantar nerve. The medial plantar nerve and lateral plantar nerve ran between B and E, at 32.4% ± 4% and 61.2%± 5.1% respectively from B. No plantar arteries were found to run between the medial plantar nerve and lateral plantar nerve on BE. Taking mean and standard deviation values into account, no neurovascular structure existed from 36.4% to 56.1% along a line between the medial aspect of the base of M1 to the proximal tip of M5. The flexor digitorum longus tendon and peroneus longus tendon passed through the deep layer of this region. Conclusion: We believe this region to be a safe zone for creating plantar endoscopic portal. The plantar central portal can be created at the center of the sole. An approach from the plantar central portal to the flexor digitorum longus tendon, flexor hallucis longus tendon, and peroneus longus tendon with the plantar lateral portal, posteromedial portal, and toe portal allows for a greater range of vision and treatment options and may further advance endoscopic surgery of the sole.

Evaluation of Metatarsal Head Resurfacing Hemiarthroplasty in the Surgical Treatment of Hallux Rigidus: A Retrospective Study and Mid- to Long-Term Follow-up

2017 ◽  
Vol 11 (1) ◽  
pp. 22-31 ◽  
Author(s):  
Musa Uğur Mermerkaya ◽  
Erkan Alkan ◽  
Mehmet Ayvaz
Keyword(s):  
Surgical Treatment ◽  
Case Series ◽  
Metatarsophalangeal Joint ◽  
Metatarsal Head ◽  
Treatment Method ◽  
Hallux Rigidus ◽  
Retrospective Case ◽  
First Metatarsophalangeal Joint

Background. The aim of this study was to evaluate the mid- to long-term outcomes of metatarsal head resurfacing hemiarthroplasty in the surgical treatment of advanced-stage hallux rigidus. Methods. We performed a retrospective review of 57 consecutive patients (25 [43.9%] males, 32 [56.1%] females; mean age, 61.0 ± 6.4 years) who underwent first metatarsal head resurfacing hemiarthroplasty (HemiCAP) for hallux rigidus between August 2007 and September 2010. Sixty-five implantations were performed in 57 patients; 8 patients underwent bilateral procedures. All patients were clinically rated prior to surgery and at the final follow-up visit using the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal-interphalangeal scale and first metatarsophalangeal joint range of motion (MTPJ ROM). Results. The median follow-up duration was 81 (range = 8-98) months. The median preoperative AOFAS score was 34 (range = 22-59) points, which had increased to 83 (range = 26-97) points at the final follow-up visit (P < .001). The median preoperative first MTPJ ROM was 25° (range = 15° to 40°), which had increased to 75° (range = 30° to 85°) at the final follow-up visit (P < .001). Conclusions. First MTPJ hemiarthroplasty is an effective treatment method that recovers toe function and first MTPJ ROM, and provides good mid- to long-term functional outcomes. Levels of Evidence: Level IV: Retrospective case series

Die Kalkaneusverschiebeosteotomie

2011 ◽  
Vol 31 (01) ◽  
pp. 33-39
Author(s):  
J. Dohle
Keyword(s):  
Tibialis Posterior ◽  
Flexor Hallucis Longus ◽  
Flexor Digitorum Longus ◽  
Operative Maßnahmen ◽  
Flexor Digitorum

ZusammenfassungBei der Kalkaneusverschiebeosteotomie handelt es sich um eine komplexe mehrdimensionale Korrekturosteotomie des hinteren Kalkaneusabschnitts. Durch Verschiebung des posterioren Fragments mit dem Tuber calcanei und dem Ansatz der Achillessehne nach medial kann ein Fersenvalgus in eine neutrale Rückfußachse überführt werden. Damit eignet sich das Verfahren als ein wesentliches Korrekturelement in der operativen Behandlung eines „erworbenen Plattfußes des Erwachsenen“. Der „erworbene Plattfuß des Erwachsenen“, früher auch als Tibialis-posterior-Dysfunktion beschrieben, ist eine progrediente Fehlstellung des gesamten Fußes mit Verlust der medialen Fußwölbung, mit Abduktion des Vorfußes gegenüber dem Rückfuß und Funktionsverlust des Fußes in der Belastungsphase. Von Johnson und Strom wurden für dieses Krankheitsbild drei Stadien unterschiedlicher Ausprägung der Pathologie beschrieben. Während im ersten Stadium noch konservative Behandlungsregime möglich sind, ist spätestens im Stadium II eine dauerhafte Korrektur der Fehlstellung nur durch komplexe operative Maßnahmen möglich. Die insuffiziente Tibialis-posterior-Sehne muss dann durch die Flexor-digitorum-longus-Sehne oder die Flexor-hallucis-longus-Sehne augmentiert werden. Zur mechanischen Entlastung der transponierten Sehne muss eine Korrekturosteotomie des Kalkaneus hinzugefügt werden. In diesem Zusammenhang hat sich die medialisierende Kalkaneus osteotomie als technisch vergleichsweise einfaches und relativ komplikationsarmes Verfahren etabliert.

scholarly journals The Prevalence and Clinical Significance of FHL Tears in Athletes with Posterior Ankle Impingement Surgery

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0034
Author(s):  
David A Porter ◽  
Angela Rund ◽  
Robert Kulwin ◽  
Madison Walrod
Keyword(s):  
Surgical Treatment ◽  
Return To Sport ◽  
Recovery Process ◽  
Flexor Hallucis Longus ◽  
Chi Square ◽  
Posterior Ankle Impingement ◽  
Magnetic Resonance Imaging Mri ◽  
One Year ◽  
Ankle Function

Category: Ankle, Hindfoot, Sports Introduction/Purpose: Posterior ankle pain in the athlete is common and thought to be caused by Flexor Hallucis Longus (FHL) tendon tear/tendinopathy or Os trigonum syndrome. The association of flexor hallucis longus (FHL) pathology in conjunction with PAIS has not been described. The purpose of this study is to report the prevalence of FHL tears in athletes who undergo surgical treatment for PAIS. We also report the outcome of 36 athletes treated with FHL repair with PAIS surgery and compare them to 122 athletes undergoing PAIS surgery without FHL tears. The utility of advanced imaging, standardized outcome scores at standard post-operative time intervals, return to sport (RTS) and time to RTS were all evaluated in the 158 athletes. Methods: Our clinical database was searched for appropriate surgical codes, and patients from 1996 through March 2016 were retrospectively collected. Inclusion criteria included surgical treatment of PAIS, age between ten and 50, and participation in recreational or competitive athletics. Exclusion criteria included other injuries that could affect return to sport or recovery process. 158 patients met these criteria, (36 dancers, 122 non-dancers). Pre-operative imaging, operative records, dorsiflexion range of motion at six weeks and one year postoperatively, and time to return to sport are reported. AAOS Foot & Ankle, and Lower Limb Core Module (FALLC) scores were obtained (six weeks, three months, and one year post-operatively). Questionnaire data and functionality scores were compared between the two groups using two-sample Student t-tests. Categorical data outcomes were compared using chi-square tests or Fisher’s exact tests. Results: 74/158 patients had magnetic resonance imaging (MRI) pre-operatively. 5/14 patients with an FHL tear had positive MRI suggesting an FHL tear, 9/14 patients with FHL tear had negative MRI (sensitivity of 0.26). FHL tears occurred in 36/158 (23%) of athletes with PAIS, 16/36 (44.4%) of dancers and 20/122 (16.4%) non-dancers. RTS did not differ between athletes with and without FHL tears, but time until RTS increased-average of 13.5 days (67.5 versus 81) with FHL repairs. Dancers with FHL tears reported increased foot pain and lower foot and ankle function at 3 months relative to those without tears. Scores were similar at one year. Conclusion: FHL tears in athletes undergoing surgical treatment for PAIS is 23% and in dancers can be as high as 44%. Pre- operative MRI has a poor sensitivity for FHL tears in this population. Concomitant FHL tear with repair during PAIS surgery does not decrease the rate of RTS or long term overall outcome. Overall, dancers have a higher rate of FHL tear at time of PAIS than non-dancers. FHL results in only a mild delay in RTS time. This is the first study to note FHL tear rate in association with PAI surgery.

Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon at the Sesamoid Area

2002 ◽  
Vol 23 (9) ◽  
pp. 801-803 ◽  
Author(s):  
José Antônio Veiga Sanhudo
Keyword(s):  
Successful Treatment ◽  
Early Recognition ◽  
Nonoperative Treatment ◽  
Flexor Hallucis Longus ◽  
Great Toe ◽  
Ballet Dancers ◽  
Longus Tendon ◽  
Stenosing Tenosynovitis

The author presents a case of stenosing tenosynovitis of the flexor hallucis longus tendon at the sesamoid area of the great toe following injury of the hallux. Although stenosing tenosynovitis of the flexor hallucis longus tendon is not rare, occurring frequently in ballet dancers, its entrapment at the sesamoid area was rarely described in the literature. Early recognition of this condition is very important for successful treatment. This patient did not respond to nonoperative treatment and surgical tenolysis was very successful for relief of the symptoms.

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