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      Four Tendinous Slips of Flexor Hallucis Longus Tendon: A Case Report

      case-report

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          Abstract

          Interindividual variability presents a rich field of study in medical sciences. During a cadaveric dissection at Louisiana State University Health Sciences Center, a rare anatomical variation was discovered in the pedal anatomy of a female cadaver. Medical students, while dissecting the sole of the foot, identified a variant tendinous structure. This aberrant tendinous slip from the flexor hallucis longus (FHL) extended to the lateral four tendons of flexor digitorum longus (FDL) along the plantar aspect of the foot. The discovery suggested that the FHL shares a functional relationship with the FDL. Application of tension to the FHL was found to result in simultaneous flexion motion in the lesser toes, from the second to the fifth digit. The presence of this anatomical variant holds considerable importance for surgical interventions, especially as a potential graft source in tendon reconstructions, warranting its documentation in this report.

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          Most cited references15

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          Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings.

          In patients with chronic Achilles tendinopathy, augmentation with flexor hallucis longus (FHL) tendon transfer can be performed to improve pain and functional limitations. There are no reports of postoperative imaging for evaluating tendon integration, inflammatory alterations or degeneration of the FHL muscle. The purpose of this study was to evaluate postoperative MR imaging based on clinical outcome and isokinetic strength. 13 patients with chronic Achilles tendinopathy (10 ruptures) underwent augmentation with FHL transfer. Clinical parameters, isokinetic strength and outcome measurements (AOFAS, SF-36) were evaluated at an average followup of 46.5 months. Qualitative and quantitative analyses of postoperative MRI were conducted using the non-operated side for comparison. All patients had a significant reduction of pain. The operated side had a torque deficit of 35% for plantar flexion. Ten patients returned to their former level of activity. MRI showed a complete integration of the FHL tendon in six patients. Fatty atrophy in the triceps surae was found in ten patients. The FHL was free of degeneration in all patients. Hypertrophy of the FHL of more than 15% was observed in eight patients. Augmentation with FHL transfer is a valuable option in the treatment of chronic Achilles tendinopathy with and without rupture. Our results demonstrate high patient satisfaction without donor site morbidity. The FHL tendon is well integrated into the Achilles tendon. Hypertrophy of the FHL muscle suggests functional incorporation into plantar flexion. The primary benefit of the operation is pain relief and increased muscle strength.
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            Anatomical study of toe flexion by flexor hallucis longus

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              Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons.

              The distal attachment of the flexor hallucis longus (FHL) tendon with the flexor digitorum longus (FDL) tendon varies antomically. The presence of a strong link between the two tendons can preserve distal function if one of the tendons is used for transfer.

                Author and article information

                Journal
                Cureus
                Cureus
                2168-8184
                Cureus
                Cureus (Palo Alto (CA) )
                2168-8184
                3 May 2024
                May 2024
                : 16
                : 5
                : e59601
                Affiliations
                [1 ] Anatomy, Louisiana State University Health Sciences Center, Shreveport, USA
                [2 ] Cellular Biology and Anatomy, Louisiana State University Health Sciences Center, Shreveport, USA
                Author notes
                Article
                10.7759/cureus.59601
                11076001
                38716366
                2cb3fa48-5f27-4d8d-bf2b-06a0211a4b2d
                Copyright © 2024, Maddox et al.

                This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 3 May 2024
                Categories
                Anatomy
                Plastic Surgery
                Physical Medicine & Rehabilitation

                variant,plantar foot,tendon slips,flexor digitorum longus,flexor hallucis longus

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