The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle

Silver, R. L.; Garza, Jaime de la; Rang, Mercer

doi:10.1302/0301-620x.67b3.3997956

Cited by 277 publications

(125 citation statements)

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“…The FDL tendon was considered to be suitable since the excursion and work percentage of peroneus brevis and FDL are similar. 25 The symptoms resolved in these two patients and both were free from pain except for some mild lateral ache in one after extensive walking, probably due to calcaneocuboid degeneration which had been noted on preoperative radiographs. Both patients had no instability of the hindfoot and were able to return to their previous level of activity, including golf.…”

Section: Discussionmentioning

confidence: 65%

Operative reconstruction after transverse rupture of the tendons of both peroneus longus and brevis

Borton

Lucas

Jomha

et al. 1998

The Journal of Bone and Joint Surgery. British volume

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Rupture of the tendons of both peroneus longus and peroneus brevis results in considerable disability. We have performed transfer of flexor digitorum longus (FDL) to peroneus brevis in two patients with lateral instability of the hindfoot due to chronic transverse tears of both tendons for which end-to-end repair was not possible. Both patients had excellent function when reviewed after eight and six years, respectively, with no symptoms. CT showed a normal appearance of the FDL in both patients, but the peroneal muscles looked abnormal. Transfer of the FDL provides a reliable solution to lateral instability of the hindfoot resulting from loss of function of both peronei.J Bone Joint Surg [Br] 1998;80-B:781-4. Received 20 April 1998; Accepted 3 June 1998 There is an increased awareness of acute and chronic injuries of the peroneal tendons especially in athletes. [1][2][3] Longitudinal tears have been well documented, 4,5 while transverse ruptures of peroneus longus may occur in the cuboid tunnel or in association with an os peroneum. Transverse ruptures of both peroneus longus and brevis are uncommon and have been described only twice. 6,7 In neither case was tendon transfer performed. We describe two patients in whom rupture of both peroneal tendons occurred with retraction of the tendon leaving a gap of 8 cm. Transfer of flexor digitorum longus (FDL) to peroneus brevis was performed, a procedure not previously described. Case reportsCase 1. A 60-year-old man presented with pain in the lateral aspect of his right foot and ankle which had lasted for three years. A feeling of instability had forced him to stop playing golf. He had difficulty in descending hills and stairs with severe pain on exercise. Three years previously while walking downhill on a golf course he had had an acute 'snap' in his ankle which he said had felt as if a golf ball had hit him. The ankle had immediately become weak. Over the next three years he was treated with strapping, anti-inflammatory drugs and three cortisone injections with relief for two to three months after each injection. As he became worse he was referred for an orthopaedic opinion. There was nothing of note in his past medical and surgical history. On examination, his calf muscles were wasted and there was tenderness over the lateral aspect of the ankle. The peroneal tendons were not palpable adjacent to the lateral malleolus. Eversion was limited to resistance against gravity only. Radiographs showed no abnormality. MRI showed thickening of both the peroneal tendons proximal to the lateral malleolus and their absence below this. It was decided to explore the peroneal region. Case 2. A 61-year-old retired man presented with pain in the outer side of his left foot and ankle, and instability for seven months. This had a sudden onset when he was rising from a chair and felt a painful 'crack' at the level of the midfoot. He subsequently noted that his ankle tended to invert as he walked and he could not play golf because of pain and instability. He had been treated with or...

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Section: Discussionmentioning

confidence: 65%

Operative reconstruction after transverse rupture of the tendons of both peroneus longus and brevis

Borton

Lucas

Jomha

et al. 1998

The Journal of Bone and Joint Surgery. British volume

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“…FDLT transfer is thus considered less likely to result in additional disability. FDLT is accessible as it is close anatomically to the tibialis posterior tendon but has the disadvantage that FDL has only half the strength of FHL and a quarter of the strength of tibialis posterior (Silver et al, 1985). Some authors have used FHL successfully with no reported weakness of push-off (Goldner, 1985).…”

Section: Discussionmentioning

confidence: 99%

Clinical significance of variations in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry

et al. 2005

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Tendon transfer of the flexor digitorum longus tendon (FDLT) or the flexor hallucis longus tendon (FHLT) into the tibialis posterior tendon is carried out in patients with tibialis posterior dysfunction. FDLT and FHLT are connected in the region of the knot of Henry. The present study has investigated the anatomical variations of this tendinous interconnection. The results could be used to determine which of the two tendons should be transected proximal to the region of the knot of Henry in the surgical treatment of tibialis posterior dysfunction. In over two-thirds of cadaver specimens investigated, tension applied solely to FHLT resulted in flexion of all digits and the hallux. On the basis of these results, we propose that identification of the tendon to be transected should be decided at the time of surgery depending on the anatomical pattern. Based on the evidence provided by 16 cadaveric dissections, transection of FDLT proximal to the region of the knot of Henry for the repair of tibialis posterior dysfunction would result in retention of function of the hallux and lesser digits in the majority of cases.

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“…[26][27][28] If the first metatarsal was still plantar flexed following these two procedures, a peroneus longus to peroneus brevis tendon transfer was performed to reduce plantar flexion of the first ray. 29,30 Through a 5 cm incision proximal to the tip of the lateral malleolus (Fig. 3b), the peroneus longus tendon was divided and sutured to the peroneus brevis tendon 31 with no.…”

Section: Methodsmentioning

confidence: 99%

Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing: A prospective cohort study

2009

Fuß & Sprunggelenk

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We studied a cohort of 26 diabetic patients with chronic ulceration under the first metatarsal head treated by a modified Jones extensor hallucis longus and a flexor hallucis longus transfer. If the first metatarsal was still plantar flexed following these two transfers, a peroneus longus to the peroneus brevis tendon transfer was also performed. Finally, if ankle dorsiflexion was < 5° with the knee extended, a Strayer-type gastrocnemius recession was performed.The mean duration of chronic ulceration despite a minimum of six months' conservative care was 16.2 months (6 to 31). A total of 23 of the 26 patients were available for follow-up at a mean of 39.6 months (12 to 61) after surgery. All except one achieved complete ulcer healing at a mean of 4.4 weeks (2 to 8) after surgery, and there was no recurrence of ulceration under the first metatarsal.We believe that tendon balancing using modified Jones extensor hallucis longus and flexor hallucis longus transfers, associated in selected cases with a peroneus longus to brevis transfer and/or Strayer procedure, can promote rapid and sustained healing of chronic diabetic ulcers under the first metatarsal head.

show abstract

The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle

Cited by 277 publications

References 1 publication

Operative reconstruction after transverse rupture of the tendons of both peroneus longus and brevis

Operative reconstruction after transverse rupture of the tendons of both peroneus longus and brevis

Clinical significance of variations in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry

Chronic diabetic ulcers under the first metatarsal head treated by staged tendon balancing: A prospective cohort study

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