• 1

    Sarrafian, SK and LK Topouzian. :Anatomy and physiology of the extensor apparatus of the toes. .J Bone Joint Surg Am 51::669. ,1969. .

  • 2

    Sandeman, JC. :The role of soft tissue correction of claw toes. .Br J Clin Pract 21::489. ,1967. .

  • 3

    Coughlin, MJ and RA Mann. : “Lesser Toe Deformities. ,” inSurgery of the Foot and Ankle, ,7th Ed. , ed byCoughlin, MJ and RA Mann. , p328. ,Mosby. ,St Louis. ,1999. .

    • Search Google Scholar
    • Export Citation
  • 4

    Richardson, EG. : “Lesser Toe Abnormalities. ,” inCampbell’s Operative Orthopaedics, ,8th Ed. , ed byCrenshaw, AH. , p99. ,Mosby–Year Book. ,St Louis. ,1992. .

    • Search Google Scholar
    • Export Citation
  • 5

    Scheck, M. :Etiology of acquired hammertoe deformity. .Clin Orthop Relat Res 123::63. ,1977. .

  • 6

    Engle, ET and DJ Morton. :Notes on foot disorders among natives of the Belgian Congo. .J Bone Joint Surg Am 13::311. ,1931. .

  • 7

    Lutter, LD. : “Toe Deformities. ,” inAtlas of Adult Foot and Ankle Surgery. , p74. ,Mosby–Year Book. ,St Louis. ,1997. .

  • 8

    Cyphers, SM and E Feiwell. :Review of the Girdlestone-Taylor procedure for clawtoes in myelodysplasia. .Foot Ankle 8::229. ,1988. .

  • 9

    Barbari, SG and K Brevig. :Correction of clawtoes by the Girdlestone-Taylor flexor-extensor transfer procedure. .Foot Ankle 5::67. ,1984. .

  • 10

    Newman, RJ and JM Fitton. :An evaluation of operative procedures in the treatment of hammertoe. .Acta Orthop Scand 50::709. ,1979. .

  • 11

    Parrish, TF. :Dynamic correction of clawtoes. .Orthop Clin North Am 4::97. ,1973. .

  • 12

    Pyper, JB. :The flexor-extensor transplant operation for claw toes. .J Bone Joint Surg Br 40::528. ,1958. .

  • 13

    Taylor, RG. :The treatment of claw toes by multiple transfers of flexor into extensor tendons. .J Bone Joint Surg Br 33::539. ,1951. .

  • 14

    Becerro de Bengoa Vallejo, R, F Viejo Tirado, JC Prados Frutos, et al. :Transfer of the flexor digitorum brevis tendon. .JAPMA 98::27. ,2008. .

    • Search Google Scholar
    • Export Citation
  • 15

    Sarrafian, SK. :Anatomy of the Foot and Ankle. , p243. ,JB Lippincott. ,Philadelphia. ,1983. .

  • 16

    Sgarlato, TE. :Transplantation of the flexor digitorum longus muscle tendon in hammertoes. .JAPA 60::383. ,1970. .

  • 17

    Marcinko, DE, A Lazerson, MD Dollard, et al. :Flexor digitorum longus tendon transfer: a simplified technique. .JAPA 74::380. ,1984. .

  • 18

    Coughlin, MJ. :Crossover second toe deformity. .Foot Ankle 8::29. ,1987. .

  • 19

    Coughlin, MJ. :Subluxation and dislocation of the second metatarsophalangeal joint. .Orthop Clin North Am 20::535. ,1989. .

  • 20

    Kuwada, GT. :A retrospective analysis of modification of the flexor tendon transfer for correction of hammer toe. .J Foot Surg 27::57. ,1988. .

  • 21

    Thompson, FM and JT Deland. :Flexor tendon transfer for metatarsophalangeal instability of the second toe. .Foot Ankle 14::385. ,1993. .

  • 22

    Gazdag, A and A Cracchiolo. :Surgical treatment of patients with painful instability of the second metatarsophalangeal joint. .Foot Ankle Int 19::137. ,1998. .

  • 23

    Boyer, ML and JK DeOrio. :Transfer of the flexor digitorum longus for the correction of lesser-toe deformities. .Foot Ankle Int 28::422. ,2007. .

  • 24

    LeDouble, AF. :Traité des variations du systéme musculaire del l’homme et de leur signification au point de vue de l’anthropologie et zoologique. , Vol2:, p327. ,Schleicher Fréres. ,Paris. ,1897. .

    • Search Google Scholar
    • Export Citation
  • 25

    Nathan, H and H Gloobe. :Flexor digitorum brevis: anatomical variations. .Anat Anz 135::295. ,1974. .

  • 26

    Testut, L. :Les anomalies musculaires chez l’homme expliqueés par l’anatomie comparée: Leur importance en anthropologie. , p588. ,Masson. ,Paris. ,1884. .

    • Search Google Scholar
    • Export Citation
  • 27

    Testut, L. :Les anomalies musculaires considérées du point de vue de la ligature des artéres. , p38. ,Doin. ,Paris. ,1892. .

  • 28

    Thompson, FM and JT Deland. :Flexor tendon transfer for metatarsophalangeal instability of the second toe. .Foot Ankle 14::385. ,1993. .

  • 29

    Gazdag, A and A Cracchiolo. :Surgical treatment of patients with painful instability of the second metatarsophalangeal joint. .Foot Ankle Int 19::137. ,1998. .

  • 30

    Coughlin, MJ. :Second metatarsophalangeal joint instability in the athlete. .Foot Ankle Int 14::309. ,1993. .

  • 31

    Kuwada, GT. :A retrospective analysis of modification of the flexor tendon transfer for correction of hammertoe. .J Foot Surg 27::57. ,1988. .

    • Search Google Scholar
    • Export Citation
  • 32

    Coughlin, MJ. :Subluxation and dislocation of the second metatarsophalangeal joint. .Orthop Clin North Am 20::535. ,1989. .

  • 33

    Thompson, FM and JT Deland. :Flexor tendon transfer for metatarsophalangeal instability of the second toe. .Foot Ankle Int 14::385. ,1993. .

  • 34

    Mendocino, RW, TK Statler, KR Saltrick, and AR Catanzariti. :Predislocation syndrome: a review and analysis of eight patients. .J Foot Ankle Surg 40::214. ,2001. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35

    Myerson, MS and HG Jung. :The role of toe flexor-to-extensor transfer in correcting metatarsophalangeal joint instability of the second toe. .Foot Ankle Int 29::675. ,2005. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36

    Bouché, RT and EJ Heit. :Combined plantar plate and hammertoe repair with flexor digitorum longus tendon transfer for chronic, severe sagittal plane instability of the lesser metatarsophalangeal joints: preliminary observations. .J Foot Ankle Surg 47::125. ,2008. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 37

    García-González, A, J Bayod, JC Prados-Frutos, et al. :Finite-element simulation of flexor digitorum longus or flexor digitorum brevis tendon transfer for the treatment of claw toe deformity. .J Biomech 42::1697. ,2009. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 38

    Chen, YG, PA Cook, MA McClinton, et al. :Microarterial anatomy of the lesser toe proximal interphalangeal joints. .J Hand Surg Am 23::256. ,1998. .

  • 39

    May, JW, LA Chai, BE Cohen, et al. :Free neurovascular flap from the first web space of the foot in hand reconstruction. .J Hand Surg Am 2::387. ,1977. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 40

    Murakami, T. :On the position and course of the deep plantar arteries, with special reference to the so-called plantar metatarsal arteries. .Okajimas Folia Anat Jpn 48::295. ,1971. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation

Dorsal Approach to Transfer of the Flexor Digitorum Brevis Tendon

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  • 1 Escuela Universitaria de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain.
  • | 2 Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain.
  • | 3 Department of Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
  • | 4 Department of Surgical Sciences, New York College of Podiatric Medicine, New York, NY.
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Background:

Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammer toe deformities. Only transposition of the flexor digitorum brevis tendon has been reported in the literature in a cadaveric study that used the dorsal and plantar approach. A search of the literature revealed no reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions through a unique dorsal cutaneous incision. We performed a cadaveric study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique dorsal cutaneous incision.

Methods:

Transposition of the flexor digitorum brevis tendon was attempted in 156 toes of cadaveric feet (52 each second, third, and fourth toes) through a unique dorsal incision.

Results:

The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes by the dorsal incision approach.

Conclusions:

Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammer toe deformities, especially in the second, third, and fourth toes. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon is essential to the success of the procedure. (J Am Podiatr Med Assoc 101(4): 297–306, 2011)

Corresponding author: Ricardo Becerro de Bengoa Vallejo, DPM, PhD, Escuela Universitaria de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain. (E-mail: ribebeva@teleline.es)