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Flexor Hallucis Longus Tendoscopy

  • Chun Man Ma
  • Tun Hing Lui
  • Tsz Lung Choi
  • Jorge Batista
  • Raymond Peter Lee
  • Cheuk-Hang Sin
Chapter

Abstract

The flexor hallucis longus (FHL) is a bipennate muscle that originates from the distal two-thirds of the posterior surface of the shaft of the fibula. It passes behind the medial malleolus, deep to the flexor retinaculum. The tendon courses through a fibro-osseous tunnel along the posterior surface of the talus and passes forward on the sole of the foot inside the fibro-osseous tunnel beneath the sustentaculum tali. A strong slip is given to the flexor digitorum longus and forms the master knots of Henry. It ends by inserting into the base of the distal phalanx of the great toe [1].

References

  1. 1.
    Snell RS. Clinical anatomy for medical students. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2000. p. 568–81.Google Scholar
  2. 2.
    Hamilton WG, Geppert MJ, Thompson FM. Pain in the posterior aspect of the ankle in dancers. Differential diagnosis and operative treatment. J Bone Joint Surg. 1996;78A:1491–500.CrossRefGoogle Scholar
  3. 3.
    Michelson J, Dunn L. Tenosynovitis of the flexor hallucis longus: a clinical study of the spectrum of presentation and treatment. Foot Ankle Int. 2005;26:291–303.CrossRefGoogle Scholar
  4. 4.
    Lui TH. Flexor hallucis longus tendoscopy: a technical note. Knee Surg Sports Traumatol Arthrosc. 2009;17:107–10.CrossRefGoogle Scholar
  5. 5.
    Lui TH, Chan KB, Chan LK. Cadaveric study of zone 2 flexor hallucis longus tendon sheath. Arthroscopy. 2010;26:808–12.CrossRefGoogle Scholar
  6. 6.
    Lui TH. Arthroscopic synovectomy for zone 2 flexor hallucis longus tenosynovitis. Arthrosc Tech. 2015;4:e403–5.CrossRefGoogle Scholar
  7. 7.
    Lui TH. Endoscopic loose body removal from zone 2 flexor hallucis longus tendon sheath. Arthrosc Tech. 2016;5:e465–9.CrossRefGoogle Scholar
  8. 8.
    Lui TH, Chow FYH. “Intersection syndrome” of the foot: treated by endoscopic release of master knot of Henry. Knee Surg Sports Traumatol Arthorsc. 2011;19:850–2.CrossRefGoogle Scholar
  9. 9.
    Lui TH. Endoscopic release of master knot of Henry. Arthrosc Tech. 2015;4:e847–50.CrossRefGoogle Scholar
  10. 10.
    Lui TH. Flexor hallucis longus (FHL) tenosynovitis and first metatarsophalangeal synovitis following penetrating nail prick injury: treated by zone 3 FHL tendoscopy and metatarsosesamoid arthroscopy. Arthrosc Tech. 2017;6:e427–33.CrossRefGoogle Scholar
  11. 11.
    Lui TH. Arthroscopic ganglionectomy of the foot and ankle. Knee Surg Sports Traumatol Arthrosc. 2014;22:1693–700.CrossRefGoogle Scholar
  12. 12.
    Lui TH. Endoscopic resection of subcutaneous lipoma and tumour-like lesion of the foot. Foot. 2016;26:36–40.CrossRefGoogle Scholar
  13. 13.
    Lui TH. Endoscopic assisted flexor hallucis tendon transfer in the management of chronic rupture of Achilles tendon. Knee Surg Sports Traumatol Arthrosc. 2007;15:1163–6.CrossRefGoogle Scholar
  14. 14.
    Lui TH. Endoscopic-assisted flexor hallucis longus transfer: harvest of the tendon at zone 2 or zone 3. Arthrosc Tech. 2015;4:e811–4.CrossRefGoogle Scholar
  15. 15.
    Lui TH. Flexor hallucis longus transfer with the whole length of the tendon: a minimally invasive approach. Foot Ankle Int. 2011;32:730–4.CrossRefGoogle Scholar
  16. 16.
    van Dijk CN, Scholten PE, Krips R. A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology. Arthroscopy. 2000;16:871–6.CrossRefGoogle Scholar
  17. 17.
    Lui TH. Lateral plantar nerve neuropraxia after FHL tendoscopy: case report and anatomic evaluation. Foot Ankle Int. 2010;31:828–31.CrossRefGoogle Scholar
  18. 18.
    Lui TH, Chow HT. Role of toe flexor tendoscopy in the management of an unusual cause of metatarsalgia. Knee Surg Sports Traumatol Arthrosc. 2006;14:654–8.CrossRefGoogle Scholar
  19. 19.
    Leslie HDH, Edwards WHB. Neglected ruptures of the Achilles tendon. Foot Ankle Clin N Am. 2005;10:357–70.CrossRefGoogle Scholar
  20. 20.
    Myerson MS. Achilles tendon ruptures. Instr Course Lect. 1999;48:219–30.PubMedGoogle Scholar
  21. 21.
    Wapner KL, Pavlock GS, Hecht PJ, et al. Repair of chronic Achilles tendon rupture with flexor hallucis longus tendon transfer. Foot Ankle. 1993;14:443–9.CrossRefGoogle Scholar
  22. 22.
    Paavola M, Kannus P, Tero A, et al. Achilles tendinopathy. J Bone Joint Surg Am. 2002;84A(11):2062–76.CrossRefGoogle Scholar
  23. 23.
    Roche A, Calder J, et al. Achilles tendinopathy: a review of the current concepts of treatment. Bone Joint J. 2013;95-B:1299–307.CrossRefGoogle Scholar
  24. 24.
    Fahlström M, Lorentzon R, Alfredson H. Painful conditions in the Achilles tendon region: a common problem in middle-aged competitive badminton players. Knee Surg Sports Traumatol Arthrosc. 2002;10:57–60.CrossRefGoogle Scholar
  25. 25.
    Holmes GB, Lin J. Etiologic factors associated with symptomatic achilles tendinopathy. Foot Ankle Int. 2006;27:952–9.CrossRefGoogle Scholar
  26. 26.
    Johansson C. Injuries in elite orienteers. Am J Sports Med. 1986;14:410–5.CrossRefGoogle Scholar
  27. 27.
    Fahlström M, Lorentzon R, Alfredson H. Painful conditions in the Achilles tendon region in elite badminton players. Am J Sports Med. 2002;30:51–4.CrossRefGoogle Scholar
  28. 28.
    Paavola M, Kannus P, Paakkala T, Pasanen M, Järvinen M. Long-term prognosis of patients with achilles tendinopathy: an observational 8-year follow-up study. Am J Sports Med. 2000;28:634–42.CrossRefGoogle Scholar
  29. 29.
    Lui TH. Treatment of chronic noninsertional Achilles tendinopathy with endoscopic Achilles tendon debridement and flexor hallucis longus transfer. Foot Ankle Spec. 2012;5:195–200.CrossRefGoogle Scholar
  30. 30.
    Hahn F, Meyer P, Maiwald C, Zanetti M, Vienne P, et al. Treatment of chronic Achilles tendinopathy and ruptures with flexor halluces tendon transfer: clinical outcome and MRI findings. Foot Ankle Int. 2008;29(8):794–802.CrossRefGoogle Scholar
  31. 31.
    Martin RL, Manning CM, Carcia CR, Conti SF, et al. An outcome study of chronic Achilles tendinosis after excision of the Achilles tendon and flexor halluces longus tendon transfer. Foot Ankle Int. 2005;26(9):691–7.CrossRefGoogle Scholar
  32. 32.
    Coull R, Flavin R, Stephens MM, et al. Flexor halluces longus tendon transfer: evaluation of postoperative morbidity. Foot Ankle Int. 2003;24(12):931–4.CrossRefGoogle Scholar
  33. 33.
    Lui TH, Chan KB, Chan LK. Zone 2 flexor hallucis longus tendoscopy: a cadaveric study. Foot Ankle Int. 2009;30:447–51.CrossRefGoogle Scholar
  34. 34.
    Lui TH. Minimally invasive flexor hallucis longus transfer in management of acute Achilles tendon rupture associated with tendinosis: a case report. Foot Ankle Spec. 2012;5:111–4.CrossRefGoogle Scholar
  35. 35.
    Mao H, Shi Z, Wapner KL, Dong W, Yin W, Xu D, et al. Anatomical study study for flexor halluces longus tendon transfer in treatment of Achilles tendinopathy. Surg Radiol Anat. 2015;37:639–47.CrossRefGoogle Scholar
  36. 36.
    Lui TH. A minimally invasive “overwrapping” technique for repairing neglected ruptures of the Achilles tendon. Foot Ankle Surg. 2014;53:806–9.CrossRefGoogle Scholar
  37. 37.
    Lui TH. Whole length flexor hallucis longus transfer with a minimally invasive approach: technique tip. Foot Ankle Int. 2011;32:730–4.CrossRefGoogle Scholar
  38. 38.
    Netter FH. Netter’s atlas of human anatomy. 2nd ed.; 1997. p. 469–70.Google Scholar
  39. 39.
    Henry AK. Extensile exposure. 2nd ed. London: Churchill Livingstone; 1970.Google Scholar
  40. 40.
    O’Sullivan E, Carare-nnadi R, Greenslade J, Bowyer G. Clinical significance of variations in the interconnections between flexor digitorum longus and flexor halluces longus in the region of the knot of Henry. Clin Anat. 2005;18(2):121–5.CrossRefGoogle Scholar
  41. 41.
    Muller T, et al. Risk of neurovascular injuries in flexor halluces longus tendon transfers: an anatomic cadaver study. Foot Ankle Int. 2007;28(8):910–5.CrossRefGoogle Scholar
  42. 42.
    Boruta PM, Beauperthuy GD. Partial tear of the flexor hallucis longus at the knot of Henry: presentation of three cases. Foot Ankle Int. 1997;18(4):243–6.CrossRefGoogle Scholar
  43. 43.
    Donovan A, Rosenberg ZS, Bencardino FT, Velez ZR, Blonder DB, Ciavarra GA, et al. Plantar tendons of the foot: MR imaging and US. Radiographics. 2013;33:2065–85.CrossRefGoogle Scholar
  44. 44.
    Lui TH, Chan KB, Chan LK. Cadaveric study of zone 2 flexor halluces longus tendon sheath. Arthroscopy. 2010;26:808–12.CrossRefGoogle Scholar
  45. 45.
    Amlang M, Rosenow MC, Friedrich A, Zwipp H, Rammelt S. Direct plantar approach to Henry’s knot for flexor halluces longus transfer. Foot Ankle Int. 2012;33(1):7–13.CrossRefGoogle Scholar
  46. 46.
    Hoppenfield S, deBoer P, Buckley R. Chapter 12, Surgical exposures in orthopaedics: the anatomic approach. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2003.Google Scholar
  47. 47.
    Schon LC, Reed MA. Chapter 12, Mann’s surgery of the foot and ankle. 9th ed. Philadelphia: Elsevier Saunders; 2014.Google Scholar
  48. 48.
    Yuen CP, Lui TH. Adhesion of flexor hallucis longus at the site of a tibial-shaft fracture – a cause of a checkrein deformity. Foot Ankle Surg. 2015;21:e23–6.CrossRefGoogle Scholar
  49. 49.
    Sinnett T, Rudge B, Clark C. A case of check-rein deformities of the great and lesser toes treated through exploration at the midfoot. Foot Ankle Surg. 2015;21:e6–8.CrossRefGoogle Scholar
  50. 50.
    Oloff LM, Schulhofer SD. Fracture of the calcaneus: an unusual fracture pattern with subtalar joint interposition of the flexor hallucis longus. A report of two cases. J Foot Ankle Surg. 1998;37:101–9.CrossRefGoogle Scholar
  51. 51.
    Dougall TW, Ashcroft GP. Flexor hallucis longus tendon interposition in a fracture of the medial tubercle of the posterior process of the talus. Injury. 1997;28:551–2.CrossRefGoogle Scholar
  52. 52.
    Burda R, Morochovic R, Kitka M. Hallux flexus – the result of posttraumatic entrapment of the flexor hallucis longus tendon in the tibial fracture site. Rozhl Chir. 2010;89:466–7.PubMedGoogle Scholar
  53. 53.
    Piper KJ, Yen-yi JC, Horsley M. Missed posterior deep, inferior subcompartment syndrome in a patient with an ankle fracture: a case report. J Foot Ankle Surg. 2010;49:398.e5–8.CrossRefGoogle Scholar
  54. 54.
    Lui TH. Endoscopic adhesiolysis of flexor hallucis longus muscle. Arthrosc Tech. 2017;6(2):e325–9CrossRefGoogle Scholar
  55. 55.
    Murphy GA. Disorders of tendons and fascia. In: Chapter 85, Campbell’s operative orthopaedics. 11th ed. Maryland Heights: Mosby Elsevier; 2008. p. 4812.Google Scholar
  56. 56.
    Maquirrian J. Posterior ankle impingement syndrome. In: Operative techniques in orthopaedic surgery. Chapter 89. Philadelphia: Lippincott Williams & Wilkins; 2011. p. 4229–33.Google Scholar
  57. 57.
    Lui TH. Endoscopic adhesiolysis of the flexor hallucis longus muscle. Foot Ankle Spec. 2014;7(6):492–4.CrossRefGoogle Scholar
  58. 58.
    Lui TH, Chan LK. Posterior ankle and hindfoot endoscopy: a cadaveric study. Foot Ankle Surg. 2016;22:186–90.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2019

Authors and Affiliations

  • Chun Man Ma
    • 1
  • Tun Hing Lui
    • 1
    • 2
    • 3
    • 4
  • Tsz Lung Choi
    • 5
  • Jorge Batista
    • 6
  • Raymond Peter Lee
    • 7
  • Cheuk-Hang Sin
    • 8
  1. 1.Department of Orthopaedics and TraumatologyNorth District HospitalHong KongChina
  2. 2.Department of OrthopaedicsSouthern Medical UniversityGuangzhouChina
  3. 3.Institute of Biomedicine and Biotechnology, Shenzhen Institute of Advanced Technology—Chinese Academy of ScienceShenzhenChina
  4. 4.Department of Orthopaedics and TraumatologyChinese University of Hong KongHong KongChina
  5. 5.Department of Orthopaedics and TraumatologyUnited Christian HospitalHong KongChina
  6. 6.Centro Artroscopico Jorge Batista SA- Club Atlético Boca JuniorsBuenos AiresArgentina
  7. 7.Department of Orthopaedics and TraumatologyPrince of Wales HospitalShatinChina
  8. 8.Department of Orthopaedics and TraumatologyPrincess Margaret HospitalKowloonChina

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