Minimally Invasive Method of Harvesting the Flexor Digitorum Longus Tendon: A Cadaver Study

2008 ◽  
Vol 29 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Vinod Kumar Panchbhavi ◽  
Jinping Yang ◽  
Santaram Vallurupalli
Keyword(s):  
Minimally Invasive ◽  
Cadaver Study ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Invasive Method ◽  
Flexor Digitorum

Transfer of the Flexor Digitorum Brevis Tendon

2008 ◽  
Vol 98 (1) ◽  
pp. 27-35 ◽  
Author(s):  
Ricardo Becerro de Bengoa Vallejo ◽  
Fermín Viejo Tirado ◽  
Juan Carlos Prados Frutos ◽  
Marta Elena Losa Iglesias ◽  
Kevin T. Jules
Keyword(s):  
Extensor Digitorum Longus ◽  
Anatomical Variation ◽  
Proximal Phalanx ◽  
Cadaver Study ◽  
Medial Aspect ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Hammer Toe ◽  
Flexor Digitorum Brevis ◽  
Flexor Digitorum

Background: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw or hammer toe deformities. In contrast, a search of the literature revealed no previous reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions. We performed a cadaver study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect. Methods: Transposition of the flexor digitorum brevis tendon was attempted in 180 toes of cadaver feet: 45 second toes, 45 third toes, 45 fourth toes, and 45 fifth toes. Results: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes and in 42 (93.3%) of the fifth toes. In the three remaining fifth toes (6.7%), the flexor digitorum brevis tendon was absent, a known anatomical variation. Conclusions: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for correction of claw or hammer toe deformities, especially in the second, third, and fourth toes. The transverse aponeurotic fibers originating from the extensor digitorum longus impede the transfer of the flexor digitorum brevis tendon, and meticulous excision of these fibers is essential to the success of the procedure. (J Am Podiatr Med Assoc 98(1): 27–35, 2008)

scholarly journals Anatomy of the Distal End of Flexor Digitorum Longus Tendon and Percutaneous Release Technique: A Cadaveric Study

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988427
Author(s):  
Baofu Wei ◽  
Ruoyu Yao ◽  
Annunziato Amendola
Keyword(s):  
Distal Phalanx ◽  
Neurovascular Bundle ◽  
Middle Phalanx ◽  
Flexor Digitorum Longus ◽  
Longus Tendon ◽  
Pull Out ◽  
Percutaneous Release ◽  
Significant Difference ◽  
Distal Interphalangeal ◽  
Flexor Digitorum

Background: The transfer of flexor-to-extensor is widely used to correct lesser toe deformity and joint instability. The flexor digitorum longus tendon (FDLT) is percutaneously transected at the distal end and then routed dorsally to the proximal phalanx. The transected tendon must have enough mobility and length for the transfer. The purpose of this study was to dissect the distal end of FDLT and identify the optimal technique to percutaneously release FDLT. Methods: Eight fresh adult forefoot specimens were dissected to describe the relationship between the tendon and the neurovascular bundle and measure the width and length of the distal end of FDLT. Another 7 specimens were used to create the percutaneous release model and test the strength required to pull out FDLT proximally. The tendons were randomly released at the base of the distal phalanx (BDP), the space of the distal interphalangeal joint (SDIP), and the neck of the middle phalanx (NMP). Results: At the distal interphalangeal (DIP) joint, the neurovascular bundle begins to migrate toward the center of the toe and branches off toward the center of the toe belly. The distal end of FDLT can be divided into 3 parts: the distal phalanx part (DPP), the capsule part (CP), and the middle phalanx part (MPP). There was a significant difference in width and length among the 3 parts. The strength required to pull out FDLT proximally was about 168, 96, and 20 N, respectively, for BDP, SDIP, and NMP. Conclusion: The distal end of FDLT can be anatomically described at 3 locations: DPP, CP, and MPP. The tight vinculum brevis and the distal capsule are strong enough to resist proximal retraction. Percutaneous release at NMP can be performed safely and effectively. Clinical Relevance: Percutaneous release at NMP can be performed safely and effectively during flexor-to-extensor transfer.

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.

Surgical Planning for Flexor Digitorum Longus Tendon Transfers: An Anatomic Study

2017 ◽  
Vol 56 (1) ◽  
pp. 47-49 ◽  
Author(s):  
Jeffrey E. McAlister ◽  
Shyler L. DeMill ◽  
Eric So ◽  
Christopher F. Hyer
Keyword(s):  
Surgical Planning ◽  
Anatomic Study ◽  
Flexor Digitorum Longus ◽  
Tendon Transfers ◽  
Longus Tendon ◽  
Flexor Digitorum
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