• 1.

    Coughlin, M. :Lesser-toe abnormalities. .J Bone Joint Surg Am 84::1446. :2002. .

  • 2.

    Coughlin, M and R Mann. : “Lesser Toe Deformities. ,” inSurgery of the Foot and Ankle. , edited byCoughlin, M and R Mann. , p320. ,Mosby-Yearbook. ,St. Louis. ,1999. .

    • Search Google Scholar
    • Export Citation
  • 3.

    Engle, E. :Notes on foot disorders among natives of the Belgian Congo. .J Bone Joint Surg 13::311. :1931. .

  • 4.

    Richardson, E. : “Lesser Toe Abnormalities. ,” inCampbell’s Operative Orthopaedics. , edited byCrenshaw, A. , p99. ,Mosby-Yearbook. ,St. Louis. ,1992. .

    • Search Google Scholar
    • Export Citation
  • 5.

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

  • 6.

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

  • 7.

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

  • 8.

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

  • 9.

    Lutter, L. : “Toe Deformities. ,” inAtlas of Adult Foot and Ankle Surgery. , p74. ,Mosby-Yearbook. ,St. Louis. ,1997. .

  • 10.

    Newman, RJ and JM Fitton. :An evaluation of operative procedures in the treatment of hammer toe. .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.

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

  • 15.

    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
  • 16.

    Bouche, 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
  • 17.

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

  • 18.

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

  • 19.

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

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

    Mendocino, R, T Statler, K Saltrick, et al. :Predislocation syndrome: a review and analysis of eight patients. .J Foot Ankle Surg 40::214. :2001. .

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22.

    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 26::675. :2005. .

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

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

  • 24.

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

  • 25.

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

  • 26.

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

  • 27.

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

  • 28.

    Hansen, S. :Functional Restoration of the Foot and Ankle. , p472. ,Lippincott Williams & Wilkins. ,Philadelphia. ,2000. .

  • 29.

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

  • 30.

    Girdlestone, GR. :Physiotherapy for hand and foot. .Physiotherapy 32::167. :1947. .

  • 31.

    LeDouble, A. :Traite des Variations du Systeme Musculaire del L’homme et de Leur Signification au Point de Vue de L’anthropologie et Zoologique. , p327. ,Schleicher Freres. ,Paris. ,1897. .

    • Search Google Scholar
    • Export Citation
  • 32.

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

  • 33.

    Testut, L. :Les Anomalies Musculaires Chez L’homme Expliquees par L’anatomie Comparee: Leur Importance en Anthropologie. , p588. ,Paris ,Masson. ,1884. .

    • Search Google Scholar
    • Export Citation
  • 34.

    Testut, L. :Les Anomolies Musculaires Considerees du Point de Vue la Ligature des arteres. , p38. ,Doin. ,Paris. ,1892. .

Single Longitudinal Dorsal Incision Approach to Transfer the Flexor Digitorum Longus Tendon Between the Flexor Digitorum Brevis Hemitendons

A Cadaveric Study

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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.
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Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammertoe deformities. The most common technique uses two cutaneous incisions, one plantar and another dorsal. We performed a cadaveric study to determine whether the flexor digitorum longus tendon could be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique single longitudinal central dorsal incision. The rationale for this novel approach was to minimize the risk of vascular compromise to the digit associated with the two-incision approach. Transposition of the flexor digitorum longus tendon was attempted in 120 toes of cadaveric feet (60 each second and third digits) through a central longitudinal dorsal incision. The flexor digitorum longus tendon segment was long enough to be successfully transposed between the flexor digitorum brevis hemitendons of the second and third toes in 100% of the cases using the central longitudinal dorsal incision approach, with a resection arthroplasty at the proximal interphalangeal joint. Transfer of the flexor digitorum longus tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammertoe deformities in the second and third digits. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon and its longitudinal incision are essential to the successful transfer of the flexor digitorum longus tendon between the flexor digitorum brevis hemitendons. (J Am Podiatr Med Assoc 103(5): 430–437, 2013)

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@enf.ucm.es)