The accessory tendon of extensor hallucis longus muscle and its correlation to hallux valgus deformity: a cadaveric study

Abstract

Purpose

The accessory tendon (AT) of the extensor hallucis longus (EHL) is a common anatomic variation, whose clinical significance remains debatable. The purpose of this study was to investigate the incidence and morphology of accessory EHL tendons in cadavers and to examine any possible correlation to the occurrence and severity of hallux valgus (HV) deformity.

Methods

We examined any possible correlation between the AT presence and the cadavers’ age and the HV deformity in 98 female adult cadaveric feet. The HV and intermetatarsal (IMA) angles were measured and compared with the relative angle between the primary EHL tendon and AT as well as the length of the AT.

Results

AT was present in 26.5% and HV deformity existed in 36.7% of all feet. There was a high prevalence (65.4%) of HV deformity in feet with AT, but the HV angle and IMA were similar in feet with AT and without AT. No significant correlations were found between AT morphological characteristics and the cadavers’ age or the HV angle and IMA.

Conclusions

In conclusion, there is a high incidence of HV deformity in cadaveric feet with AT of EHL (almost 2/3), but there is no correlation between the severity of the HV deformity and the presence or characteristics of the AT.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

References

  1. 1.

    Aktekin M, Uzmansel D, Kurtoglu Z, Sanli EC, Kara AB (2008) Examination of the accessory tendons of extensor hallucis longus muscle in fetuces. Clin Anat 21:713–717

    Article  PubMed  Google Scholar 

  2. 2.

    Al-Saggaf S (2003) Variations in the insertion of the extensor hallucis longus muscle. Folia Morphol (Warsz) 62:147–155

    Google Scholar 

  3. 3.

    Arinci Incel N, Genç H, Erdem HR, Yorgancioglu ZR (2003) Muscle imbalance in hallux valgus: an electromyographic study. Am J Phys Med Rehabil 82:345–349

    PubMed  Google Scholar 

  4. 4.

    Bayer T, Kolodziejski N, Flueckiger G (2014) The extensor hallucis capsularis tendon—a prospective study of its occurrence and function. Foot Ankle Surg 20:192–194

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Bergman RA, Afifi AK (2014) Atlas of human anatomy, anatomy atlases is a digital library of anatomy information. http://www.anatomyatlases.org

  6. 6.

    Bibbo C, Arangio G, Patel DV (2004) The accessory extensor tendon of the first metatarsophalangeal joint. Foot Ankle Int 25:387–390

    Article  PubMed  Google Scholar 

  7. 7.

    Coughlin MJ, Jones CP (2007) Hallux valgus: demographics, etiology and radiographic assessment. Foot Ankle Int 28:759–777

    Article  PubMed  Google Scholar 

  8. 8.

    Denk CC, Oznur A, Sürücü HS (2002) Double tendons at the distal attachment of the extensor hallucis longus muscle. Surg Radiol Anat 24:50–52

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Fuhrmann RA, Layher F, Wetzel WD (2003) Radiographic changes in forefoot geometry with weight bearing. Foot Ankle Int 24:326–331

    Article  PubMed  Google Scholar 

  10. 10.

    Hoffmeyer P, Cox JN, Blanc Y, Meyer JM, Taillard W (1988) Muscle in hallux valgus. Clin Orthop Relat Res 232:112–118

    Google Scholar 

  11. 11.

    Iida M, Basmajian JV (1974) Electromyography of hallux valgus. Clin Orthop Relat Res 101:220–224

    Google Scholar 

  12. 12.

    Lundeen RO, Latva D, Yant J (1983) The secondary tendinous slip of the extensor hallucis longus (extensor ossis metatarsi hallucis). J Foot Surg 22:142–144

    CAS  PubMed  Google Scholar 

  13. 13.

    MacAlister A (1872) Additional observations on muscular anomalies in human anatomy (third series) with a catalogue of the principal muscular variations hitherto published. Trans Roy Irish Acad Sci 25:1–134

    Google Scholar 

  14. 14.

    MacAlister A (1871) On some points in the myology of the chimpanzee and others of the primates. Annals and magazine of natural history. Proc R Ir Acad 4:341–351

    Google Scholar 

  15. 15.

    Mann RA, Coughlin MJ (1986) Hallux valgus and complications of hallux valgus. In: Mann RA (ed) Surgery of the foot, 5th edn. CV Mosby, St Louis, pp 65–130

    Google Scholar 

  16. 16.

    Mann RA, Coughlin MJ (1981) Hallux valgus-etiology, anatomy, treatment and surgical considerations. Clin Orthop Relat Res 157:31–41

    Google Scholar 

  17. 17.

    Miller MD (2008) Review of orthopaedics: expert consult—online and print, 5th edn. Saunders Elsevier, Philadelphia, pp 366–367

    Google Scholar 

  18. 18.

    Nix S, Smith M, Vicenzino B (2010) Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res 27:21

    Article  Google Scholar 

  19. 19.

    Roddy E, Zhang W, Doherty M (2008) Prevalence and associations of hallux valgus in a primary care population. Arthritis Rheum 15(59):857–862

    Article  Google Scholar 

  20. 20.

    Sim-Fook L, Hodgson AR (1958) A comparison of foot forms among the non-shoe and shoe wearing Chinese population. J Bone Joint Surg Am 40:1058–1062

    Article  PubMed  Google Scholar 

  21. 21.

    Tate R, Pachnik RL (1976) The accessory tendon of extensor hallucis longus: its occurrence and function. J Am Podiatry Assoc 66:899–907

    CAS  Article  PubMed  Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to K. Natsis.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Natsis, K., Konstantinidis, G.A., Symeonidis, P.D. et al. The accessory tendon of extensor hallucis longus muscle and its correlation to hallux valgus deformity: a cadaveric study. Surg Radiol Anat 39, 1343–1347 (2017). https://doi.org/10.1007/s00276-017-1881-4

Download citation

Keywords

  • Extensor hallucis longus muscle
  • Accessory tendon
  • Hallux abductovalgus
  • Tendon imbalance
  • Hallux valgus
  • Anatomical variations