CC BY-NC-ND 4.0 · Journal of Morphological Sciences 2018; 35(03): 177-179
DOI: 10.1055/s-0038-1675225
Brief Communication
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

A Complex Cross Link between the Tendons of Flexor Hallucis Longus and Flexor Digitorum Longus

Srinivasa Rao Sirasanagandla
1   Department of Human and Clinical Anatomy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Oman
,
Varna Taranikanti
2   Department of Foundational Medical Studies, Oakland University William Beaumont School of Medicine, Rochester, MI 48309, USA
,
Raghu Jetti
3   Department of Basic Medical Sciences, College of Applied Medical Sciences, King Khalid University, Abha, Kingdom of Saudi Arabia
› Author Affiliations
Further Information

Publication History

03 March 2017

03 September 2018

Publication Date:
31 October 2018 (online)

Abstract

Anatomical variations involving the flexor digitorum longus (FDL) and flexor hallucis longus (FHL) tendons are clinically important because of their significant role in reconstructive surgeries of tibialis posterior tendon insufficiencies and Achilles tendinopathies. Harvesting of grafts from these complex variations of FDL and FHL are surgically challenging. In the present case, we report a complex structural cross link between the FDL and FHL associated with morphological variations of the first lumbrical and flexor digitorum accessorius (FDA) attachments. A connecting slip from FHL was found to be inserted into the FDL tendon of the second toe. The FDA was inserted into the fibular side of the connecting slip of the FHL as well as into the FDL tendons of the third and fourth toes. The first lumbrical took origin from the tibial side of FHL connecting slip and from the tibial side of FDL tendon for second toe.

 
  • References

  • 1 Standring S, Borley NR, Collins P. , et al. Gray's Anatomy. Pectoral region, shoulder region and axilla. 40th ed. London: Churchill Livingstone; 2008. , p. 2647-48
  • 2 Mao H, Shi Z, Wapner KL, Dong W, Yin W, Xu D. Anatomical study for flexor hallucis longus tendon transfer in treatment of Achilles tendinopathy. Surg Radiol Anat 2015; 37 (06) 639-647
  • 3 Hahn F, Meyer P, Maiwald C, Zanetti M, Vienne P. Treatment of chronic achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings. Foot Ankle Int 2008; 29 (08) 794-802
  • 4 Schon LC, Shores JL, Faro FD, Vora AM, Camire LM, Guyton GP. Flexor hallucis longus tendon transfer in treatment of Achilles tendinosis. J Bone Joint Surg Am 2013; 95 (01) 54-60
  • 5 LaRue BG, Anctil EP. Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons. Foot Ankle Int 2006; 27 (07) 528-532
  • 6 Plaass C, Abuharbid G, Waizy H, Ochs M, Stukenborg-Colsman C, Schmiedl A. Anatomical variations of the flexor hallucis longus and flexor digitorum longus in the chiasma plantare. Foot Ankle Int 2013; 34 (11) 1580-1587
  • 7 Hur MS, Kim JH, Woo JS, Choi BY, Kim HJ, Lee KS. An anatomic study of the quadratus plantae in relation to tendinous slips of the flexor hallucis longus for gait analysis. Clin Anat 2011; 24 (06) 768-773
  • 8 Macalister A. On muscular anomalies in human anatomy, and their bearing upon homotypical myology. Proceedings of the Royal Irish Academy 1866; –69 10: 126-164
  • 9 Fayazi AH, Nguyen HV, Juliano PJ. Intermediate term follow-up of calcaneal osteotomy and flexor digitorum longus transfer for treatment of posterior tibial tendon dysfunction. Foot Ankle Int 2002; 23 (12) 1107-1111
  • 10 Myerson MS, Badekas A, Schon LC. Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy. Foot Ankle Int 2004; 25 (07) 445-450
  • 11 Schuh R, Gruber F, Wanivenhaus A, Hartig N, Windhager R, Trnka HJ. Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for the treatment of stage II posterior tibial tendon dysfunction: kinematic and functional results of fifty one feet. Int Orthop 2013; 37 (09) 1815-1820
  • 12 Trnka HJ. Dysfunction of the tendon of tibialis posterior. J Bone Joint Surg Br 2004; 86 (07) 939-946