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Impact of intertendinous connections between the flexor digitorum brevis and longus on percutaneous tenotomy for the treatment of claw toes: an anatomic and ultrasound study

  • Anatomic Bases of Medical, Radiological and Surgical Techniques
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Abstract

Purpose

Selective percutaneous tenotomy of the flexor digitorum longus (FDL) is a treatment for claw toes that gives astonishingly good functional results despite tendon sacrifice. However, the involution of the FDL tendon stump after tenotomy is unknown. The aim of our study was to assess the involution of the tendon stump after selective percutaneous tenotomy of the FDL.

Methods

The study included two parts. In the clinical part, an ultrasound analysis of 15 FDL tenotomies in 7 patients was carried out 3 months post-surgery. In the anatomic part, the feet of 10 bodies donated to science were dissected and examined anatomically.

Results

The proximal stump of the FDL was located near the base of the proximal phalanx and moved synchronously with the flexor digitorum brevis (FDB).Separating the FDB and FDL revealed a large tissue connection between the plantar surface of the tendinous chiasm of the FDB and the dorsal part of the FDL. These connections had significant resistance ranging from 2 to 9 Newtons depending on the toe. Tenotomy of the FDL followed by proximal traction of it led to retraction of the stump up to the base of the proximal phalanx and transfer of its action to the FDB by tensioning the intertendinous structure. Histologically, these structures were mostly comprised of tendon connective tissue. Their vascular component was small.

Conclusion

The presence of this intertendinous connection leads, in the case of isolated tenotomy of the FDL, to equivalent transfer of the latter to the FDB.

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Acknowledgements

We thank Professor François Bonnel (Montpellier, France) for his comments and advice in the preparation of this manuscript and Mr. Bruno Belloncle for his technical assistance.

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Institut Clinique du Pied-Paris, Ramsay Santé, Clinique Blomet, 136 rue Blomet, 75015, Paris, France

    Julien Beldame

  2. Department of Orthopaedic Surgery, Rouen University Hospital, 37 Boulevard Gambetta, 76000, Rouen, France

    Matthieu Lalevée, Sixtine Regnard, Florent Marguet, Marie Csanyi-Bastien & Fabrice Duparc

  3. Clinique Mégival, Vivalto santé, 1328 Avenue Maison-Blanche, 76550, Saints Aubin sur Scie, France

    Marion Masse

  4. Laboratory of Anatomy, Faculty of Medicine-Pharmacy, Rouen Normandy University, 22 boulevard Gambetta, 76183, Rouen, France

    Fabrice Duparc

Authors
  1. Julien Beldame
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  2. Matthieu Lalevée
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  3. Sixtine Regnard
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  4. Florent Marguet
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  5. Marie Csanyi-Bastien
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  6. Marion Masse
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  7. Fabrice Duparc
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Contributions

JB: conceptualization, methodology, dissection, analysis, writing, editing; ML and SR: dissection, writing; FM and MC-B: histological study; MM: analysis, writing; FD: methodology, supervision, writing, editing.

Corresponding author

Correspondence to Julien Beldame.

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Conflict of interest

The authors declare no conflicts of interest.

Ethics approval

The study was performed in agreement with the current rules for research of the University of Rouen-Normandy.

Consent to participate

All patients gave their consent to participate in the study. All donors to the donated body program gave their signed consent for the anatomic studies.

Consent for publication

All patients gave their consent for the publication of their ultrasound images. All donors to the donated body program gave their signed consent for publication.

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Beldame, J., Lalevée, M., Regnard, S. et al. Impact of intertendinous connections between the flexor digitorum brevis and longus on percutaneous tenotomy for the treatment of claw toes: an anatomic and ultrasound study. Surg Radiol Anat 43, 1067–1073 (2021). https://doi.org/10.1007/s00276-021-02723-8

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  • DOI: https://doi.org/10.1007/s00276-021-02723-8

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