Closed Rupture of the Flexor Hallucis Longus Tendon in a Long Distance Runner: Report of a Case and Review of the Literature

Romash, Michael M.

doi:10.1177/107110079401500806

Cited by 36 publications

(41 citation statements)

References 6 publications

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“…[24][25][26][27][28][29] Our five patients had some weakness in eversion for four months, consistent with reports of other vascularised fibular grafts, 30 but all had a normal gait at six months, with no hyperextension of the interphalangeal joint of the hallux. The fibula-FHL flap provides good muscle cover, which has theoretical advantages in chronic osteomyelitis.…”

supporting

confidence: 71%

The Fibula-Flexor Hallucis Longus Osteomuscular Flap

Ruch

Koman

1997

The Journal of Bone and Joint Surgery. British volume

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Limb salvage after loss of bone and soft tissue may require many operations to obtain soft-tissue cover and bony continuity. We describe a fibula-flexor hallucis longus osteomuscular flap which can provide both soft tissue and bone in a single stage. The flap is based on the peroneal vessels and is covered by a split-thickness skin graft.We report the results in five patients with an average bone defect of 8.3 cm and soft-tissue and skin loss. All regained a normal gait on the donor side; four had clinical and radiological union with excellent soft-tissue cover, but one required later amputation due to diffuse coagulopathy.The flap provides free vascularised bone with muscle cover. It has a dependable, long pedicle with minimal morbidity at the donor site, and allows monitoring of the vascularity of the fibular graft. The use of vascularised bone grafts is well recognised.

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supporting

confidence: 71%

The Fibula-Flexor Hallucis Longus Osteomuscular Flap

Ruch

Koman

1997

The Journal of Bone and Joint Surgery. British volume

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“…In this context, it is interesting to note that most reported cases of flexor avulsion fracture and/or tendon failure in humans were sustained during prolonged walking and running, such as military marches and marathons (e.g. Coghlan and Clarke, 1993;Romash, 1994).…”

Section: Discussionmentioning

confidence: 99%

Walking, running and the evolution of short toes in humans

Rolian

Lieberman

Hamill

et al. 2009

Journal of Experimental Biology

136

119

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SUMMARYThe phalangeal portion of the forefoot is extremely short relative to body mass in humans. This derived pedal proportion is thought to have evolved in the context of committed bipedalism, but the benefits of shorter toes for walking and/or running have not been tested previously. Here, we propose a biomechanical model of toe function in bipedal locomotion that suggests that shorter pedal phalanges improve locomotor performance by decreasing digital flexor force production and mechanical work, which might ultimately reduce the metabolic cost of flexor force production during bipedal locomotion. We tested this model using kinematic, force and plantar pressure data collected from a human sample representing normal variation in toe length (N=25). The effect of toe length on peak digital flexor forces, impulses and work outputs was evaluated during barefoot walking and running using partial correlations and multiple regression analysis, controlling for the effects of body mass, whole-foot and phalangeal contact times and toe-out angle. Our results suggest that there is no significant increase in digital flexor output associated with longer toes in walking. In running, however, multiple regression analyses based on the sample suggest that increasing average relative toe length by as little as 20% doubles peak digital flexor impulses and mechanical work, probably also increasing the metabolic cost of generating these forces. The increased mechanical cost associated with long toes in running suggests that modern human forefoot proportions might have been selected for in the context of the evolution of endurance running.

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“…Of the 8 cases of complete subcutaneous FHL tendon rupture previously described [7][8][9][10][11][12][13][14], 2 were caused by an acute trauma. Krackow [10] reported the case of an athlete who ruptured his FHL tendon while diving, and Rasmussen and Thyssen [11] described a young man who incurred the same injury when kicking a small Fig.…”

Section: Discussionmentioning

confidence: 99%

“…The rupture occurred at the first metatarsal head in correspondence to the fibro-osseous tunnel constituted by the sesamoids and the flexor hallucis brevis (FHB) tendon. Only one other case in the previous literature showed a tendon injury at the same level [12]. …”

mentioning

confidence: 99%

“…In the absence of a predisposing systemic disease, complete subcutaneous rupture of the FHL tendon is a rare injury. From 1980 only 8 cases [7][8][9][10][11][12][13][14] have been described, including 5 in athletes [7][8][9][10]12].This paper describes a case of complete subcutaneous rupture of the FHL tendon in a young amateur athlete who had no systemic predisposing factors. The rupture occurred at the first metatarsal head in correspondence to the fibro-osseous tunnel constituted by the sesamoids and the flexor hallucis brevis (FHB) tendon.…”

mentioning

confidence: 99%

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Closed subcutaneous rupture of the flexor hallucis longus tendon. Case report and review of the literature

Grispigni¹,

Ponti²,

Danasini³

et al. 2000

J Orthopaed Traumatol

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IntroductionComplete flexor hallucis longus (FHL) tendon ruptures are usually the result of deep cuts in the sole of the foot or at the base of the toe in people who walk, run or practice sports barefoot [1,2]. Closed lesions, ranging from tendinitis to partial ruptures, are frequently found not only in ballet dancers [3,4] and athletes in general [4,5], but also in ordinary people [6]. In the absence of a predisposing systemic disease, complete subcutaneous rupture of the FHL tendon is a rare injury. From 1980 only 8 cases [7][8][9][10][11][12][13][14] have been described, including 5 in athletes [7][8][9][10]12].This paper describes a case of complete subcutaneous rupture of the FHL tendon in a young amateur athlete who had no systemic predisposing factors. The rupture occurred at the first metatarsal head in correspondence to the fibro-osseous tunnel constituted by the sesamoids and the flexor hallucis brevis (FHB) tendon. Only one other case in the previous literature showed a tendon injury at the same level [12]. Case reportA 27-year-old warehouseman, amateur football player, came to our observation with growing pain and swelling of the right big toe. There was no trauma history. He started having pain about 10 months earlier. The pain increased when he walked or stood for a long period and decreased when he was resting. No relief was obtained with instrumental physiotherapy. After approximately 8 months, active plantar flexion of the big toe became suddenly impossible.Sonography and magnetic resonance imaging confirmed clinical diagnosis of the subcutaneous rupture of the FHL tendon and evidenced the site and the extent of the lesion.On surgery the distal caput of the FHL tendon was found to be interrupted at about 3 cm from its attachment. The tendon was frayed, rolled and attached to its sheath (Fig. 1). The proximal caput was retracted at the level of the FHB muscle. Having adjusted the stumps and verified that it was impossible to perform a termino-terminal suture, the distal caput of the FHL tendon was sutured on the attachment of the FHB tendon at the base of the proximal phalanx (Fig. 2).Abstract A case of complete closed rupture of the flexor hallucis longus (FHL) tendon at the level of the first metatarsal head in a young athlete is discussed. In the absence of systemic diseases as predisposing factors, this injury is a rare event. Available literature reports eight cases, only one of which showed the same lesion pattern as in the case we describe. As termino-terminal tendon suture was impossible, a suture of the FHL distal caput on the flexor hallucis brevis tendon was performed. This avoided hyperextension of the distal phalanx and achieved the overall plantar flexion of the big toe.

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Closed Rupture of the Flexor Hallucis Longus Tendon in a Long Distance Runner: Report of a Case and Review of the Literature

Cited by 36 publications

References 6 publications

The Fibula-Flexor Hallucis Longus Osteomuscular Flap

The Fibula-Flexor Hallucis Longus Osteomuscular Flap

Walking, running and the evolution of short toes in humans

Closed subcutaneous rupture of the flexor hallucis longus tendon. Case report and review of the literature

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