Anatomical Characteristics of Extensor Hallucis Longus Tendon Variations and Its Clinical Implications: A Korean Cadaveric Study

Abstract

The purpose of this study is to ascertain the morphological characteristics of the extensor hallucis longus (EHL) tendon variation using larger-scale dissection of Korean cadavers and to classify the types of variation along with incidence. A total of 158 feet from adult formalin-fixed cadavers (50 males, 29 females) were dissected. The morphological characteristics and measurements of the EHL tendon variants were evaluated. Three types of the EHL tendon variation were classified, wherein the most common type was Type 2 (106 feet, 67.1%), Type 3 (3 feet, 1.9%) was the rarest type, and Type 1 without accessory tendon was found in 49 feet (31.0%). Type 2K (11 feet, 7%) and Type 3K (1 foot, 0.6%) were described as new subtypes. The present study suggests morphological characteristics of the EHL tendon variation in Korean populations and high morphological variability of the EHL tendon along with the possibility of differences according to race or ethnicity and gender. Furthermore, a newly updated classification complemented by new subtypes of variation will help foot and ankle surgeons in diagnosis and surgical planning with hallux problems.

Improving the Accuracy of Metatarsal Osteotomies in Minimally Invasive Foot Surgery Using a Digital Inclinometer: Preliminary Study

“…By standardizing other surgical variables through the cadaver model, we could directly quantify the differences in angular precision between conventional freehand osteotomies and those conducted using the inclinometer. This controlled comparative testing in cadavers paralleled similar research modalities in orthopedic surgery examining techniques [32][33][34][35]. Our cadaveric protocol and testing methods reinforced the validity and potential generalizability of our findings.…”

Unraveling the anatomy of toe extensors: An aid to the clinical implications

“…Many studies are documented to show multiple muscular variations, unilateral, or bilateral, in extensors of foot in cadavers. [6][7][8][9][10][11][12][13][14][15] In the present study, bifurcation of EHL tendon was having medial and lateral slips. Medial slip was the main extensor tendon of great toe, whereas lateral slip was extensor tendon of 2 nd toe.…”

“…4 These variations manifest as painful foot on some occasions due to impingement of the surrounding structures. 5 Although various studies have already been conducted representing the variations in extensor tendons of foot, [6][7][8][9][10][11][12][13][14][15] the variations found in our study are rare and have not been previously reported in the literature. Description of tendons in foot is prerequisite for the surgeons to decide for suitable graft in various reconstructive surgeries and for the analysis of injuries in tendons.…”

“…Accessory tendons of EHL muscle has been found in multiple studies with variable representations. 11,17,18 Structure and function of the accessory tendons of EHL were described to suggest the novel treatments of hallux valgus deformity. 2 An idea of classification of different patterns of EHL tendon had been offered according to the numbers of accessory tendons and their distal insertions.…”