Plantar Forces in Flexor Hallucis Longus Versus Flexor Digitorum Longus Transfer in Adult Acquired Flatfoot Deformity

Spratley, E. Meade; Arnold, John M.; Owen, John R.; Glezos, Christopher D.; Adelaar, Robert S.; Wayne, Jennifer S.

doi:10.1177/1071100713487724

Cited by 24 publications

(19 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Several reports have given successful outcomes with the usage of FHL tendon grafts, especially in Achilles tendon repair surgeries. 25 , 26 Besides, Spratley et al 27 proposed using FHL tendon grafts instead of FDL tendon grafts in posterior tibial tendon dysfunction. However, nerve injuries or toe deformities after FHL tendon transfers were also reported, particularly while harvesting this tendon distal to the MKH.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of Master Knot of Henry: A morphometric study on cadavers

Beğer

Elvan

Keskinbora

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

View full text Add to dashboard Cite

ObjectiveThe objective of this study was to evaluate the features of flexor hallucis longus (FHL), flexor digitorum longus (FDL) and flexor digitorum accessorius (FDA) muscles with relevance to the tendon grafts and to reveal the location of Master Knot of Henry (MKH).MethodsTwenty feet from ten formalin fixed cadavers were dissected, which were in the inventory of Anatomy Department of Medicine Faculty, Mersin University. The location of MKH was identified. Interconnections of FHL and FDL were categorized. According to incision techniques, lengths of FHL and FDL tendon grafts were measured. Attachment sites of FDA were assessed.ResultsMKH was 12.61 ± 1.11 cm proximal to first interphalangeal joint, 1.75 ± 0.39 cm below to navicular tuberosity and 5.93 ± 0.74 cm distal to medial malleolus. The connections of FHL and FDL were classified in 7 types. Tendon graft lengths of FDL according to medial and plantar approaches were 6.14 ± 0.60 cm and 9.37 ± 0.77 cm, respectively. Tendon graft lengths of FHL according to single, double and minimal invasive incision techniques were 5.75 ± 0.63 cm, 7.03 ± 0.86 cm and 20.22 ± 1.32 cm, respectively. FDA was found to be inserting to FHL slips in all cases and it inserted to various surfaces of FDL.ConclusionThe exact location of MKH and slips was determined. Two new connections not recorded in literature were found. It was observed that the main attachment site of FDA was the FHL slips. The surgical awareness of connections between the FHL, FDL and FDA, which participated in the formation of long flexor tendons of toes, could be important for reducing possible loss of function after tendon transfers postoperatively.

show abstract

Section: Discussionmentioning

confidence: 99%

Anatomy of Master Knot of Henry: A morphometric study on cadavers

Beğer

Elvan

Keskinbora

et al. 2018

Acta Orthopaedica et Traumatologica Turcica

View full text Add to dashboard Cite

show abstract

“…14,21,52,56,61 FDL may be favored because the tendon courses adjacent to the PTT (facilitating the approach), it is straightforward to locate anatomically, and its function is more expendable than great toe function; however, it is biomechanically weaker than the FHL. 8,52,109 The FHL has a larger size and was superior in a biomechanical study, although this has not been demonstrated in clinical scenarios. 8,109 In either case, tendon transfer alone is weak biomechanically and does not change the medial longitudinal arch height or hindfoot valgus deformity.…”

Section: Tendon Transfermentioning

confidence: 98%

“…The FDL and FHL are identified distal to the knot of Henry and tenodesed distally to the knot with a nonabsorbable suture to preserve some flexion force. 109 The FDL is then transected proximal to this location but distal to the knot of Henry. This allows sufficient length for the FDL tendon to be transferred to the navicular, where it is secured through a drill hole.…”

Section: Authors' Preferred Operative Treatmentmentioning

confidence: 99%

Adult-Acquired Flatfoot Deformity

Henry

Shakked

Ellis

2019

Foot & Ankle Orthopaedics

142

View full text Add to dashboard Cite

Adult-acquired flatfoot deformity (AAFD) comprises a wide spectrum of ligament and tendon failure that may result in significant deformity and disability. It is often associated with posterior tibial tendon deficiency (PTTD), which has been linked to multiple demographic factors, medical comorbidities, and genetic processes. AAFD is classified using stages I through IV. Nonoperative treatment modalities should always be attempted first and often provide resolution in stages I and II. Stage II, consisting of a wide range of flexible deformities, is typically treated operatively with a combination of soft tissue procedures and osteotomies. Stage III, which is characterized by a rigid flatfoot, typically warrants triple arthrodesis. Stage IV, where the flatfoot deformity involves the ankle joint, is treated with ankle arthrodesis or ankle arthroplasty with or without deltoid ligament reconstruction along with procedures to restore alignment of the foot. There is limited evidence as to the optimal procedure; thus, the surgical indications and techniques continue to be researched.

show abstract

“…In these cases, each procedure specifically addresses different portions of the deformity. In almost every case, augmentation of the PTT is performed with either the Flexor Digitorum Longus (FDL) or the Flexor Hallucis Longus (FHL) with a FHL tendon transfer growing in occurrence . From there, the choice is whether or not to use a hindfoot procedure with the Medializing Calcaneal Osteotomy (MCO), a lateral column lengthening (LCL) procedure with the Evans Osteotomy, Calcaneocuboid Distraction Arthrodesis (CCDA), or the Z Osteotomy, or a combination of both hindfoot and a single LCL procedure …”

mentioning

confidence: 99%

Patient specific computational models to optimize surgical correction for flatfoot deformity

2016

Self Cite

View full text Add to dashboard Cite

Several surgically corrective procedures are considered to treat Adult Acquired Flatfoot Deformity (AAFD) patients, relieve pain, and restore function. Procedure selection is based on best practices and surgeon preference. Recent research created patient specific models of AAFD to explore their predictive capabilities and examine effectiveness of the surgical procedure used to treat the deformity. The models' behavior was governed solely by patient bodyweight, soft tissue constraints, muscle loading, and joint contact without the assumption of idealized joints. The current work expanded those models to determine if an alternate procedure would be more effective for the individual. All procedures incorporated first a tendon transfer and then included one hindfoot procedure, the Medializing Calcaneal Osteotomy (MCO), and one of three lateral column procedures: Evans osteotomy, Calcaneocuboid Distraction Arthrodesis (CCDA), Z osteotomy, and the combination procedures MCO & Evans osteotomy, MCO & CCDA, and MCO & Z osteotomy. The combination MCO & Evans and MCO & Z procedures were shown to provide the greatest amount of correction for both forefoot abduction and hindfoot valgus. However, these two procedures significantly increased joint contact force, specifically at the calcaneocuboid joint, and ground reaction force along the lateral column. With exception to the lateral bands of the plantar fascia and middle spring ligament, the strain present in the plantar fascia, spring, and deltoid ligaments decreased after all procedures. The use of patient specific computational models provided the ability to investigate effects of alternate surgical corrections on restoring biomechanical function in these flatfoot patients. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1523-1531, 2017.

show abstract

Plantar Forces in Flexor Hallucis Longus Versus Flexor Digitorum Longus Transfer in Adult Acquired Flatfoot Deformity

Abstract: This cadaveric study shows that the FHL is more biomechanically suitable for tibialis posterior tendon insufficiency than the FDL, which may be a basis for a study to investigate whether it is superior in a clinical situation.

Cited by 24 publications

References 31 publications

Anatomy of Master Knot of Henry: A morphometric study on cadavers

Anatomy of Master Knot of Henry: A morphometric study on cadavers

Adult-Acquired Flatfoot Deformity

Patient specific computational models to optimize surgical correction for flatfoot deformity

Contact Info

Product

Resources

About