O'Sullivan E, Carare-Nnadi R, Greenslade J, et al: Clinical significance of variations in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry. Clin Anat18: 121, 2005.
O'Sullivan E, Carare-Nnadi R, Greenslade J, et al: Clinical significance of variations in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry. Clin Anat18: 121, 2005.1569652310.1002/ca.20029)| false
Lui TH, Chow FY: “Intersection syndrome” of the foot: treated by endoscopic release of the master knot of Henry. Knee Surg Sports Traumatol Arthrosc19: 850, 2011.10.1007/s00167-010-1394-821290112)| false
Wapner KL, Hecht PJ, Shea JR, et al: Anatomy of second muscular layer of the foot: considerations for tendon selection in transfer for Achilles and posterior tibial tendon reconstruction. Foot Ankle Int15: 420, 1994.
Wapner KL, Hecht PJ, Shea JR, et al: Anatomy of second muscular layer of the foot: considerations for tendon selection in transfer for Achilles and posterior tibial tendon reconstruction. Foot Ankle Int15: 420, 1994.798181210.1177/107110079401500803)| false
Fernandes R, Aguiar R, Trudell D, et al: Tendons in the plantar aspect of the foot: MR imaging and anatomic correlation in cadavers. Skeletal Radiol36: 115, 2007.1703385110.1007/s00256-006-0203-4)| false
Oddy MJ, Flowers MJ, Davies MB: Flexor digitorum longus tendon exposure for flatfoot reconstruction: a comparison of two methods in a cadaveric model. Foot Ankle Surg16: 87, 2010.10.1016/j.fas.2009.06.003)| false
Sartoris DJ, Devine S, Resnick D, et al: Plantar compartmental infection in the diabetic foot: the role of computed tomography. Invest Radiol20: 772, 1985.10.1097/00004424-198511000-000033865915)| false
Ledermann HP, Morrison WB, Schweitzer ME, et al: Tendon involvement in pedal infection: MR analysis of frequency, distribution, and spread of infection. AJR Am J Roentgenol179: 939, 2002.10.2214/ajr.179.4.179093912239042)| false
Aragon-Sanchez J, Lazaro-Martinez JL, Pulido-Duque J, et al: From the diabetic foot ulcer and beyond: how do foot infections spread in patients with diabetes?
Diabet Foot Ankle
It is important to have a full appreciation of lower-extremity anatomical relationships before undertaking diabetic foot surgery. We sought to evaluate the potential for communication of the flexor hallucis longus (FHL) tendon with other pedal tendons and plantar foot compartments at the master knot of Henry and to provide cadaveric images and computed tomographic (CT) scans of such communications. Computed tomography and subsequent anatomical dissection were performed on embalmed cadaveric limbs. Initially, 5 to 10 mL (1:4 dilution) of iohexol and normal saline was injected into the FHL sheath as it coursed between the two hallux sesamoids. Subsequently, CT scans were obtained in the axial plane using a multidetector CT scanner with sagittal and coronal reformatted images. The limbs were then dissected for specific evaluation of the known variable intertendinous connections between the FHL and flexor digitorum longus (FDL) and quadratus plantae (QP) muscles. One cadaver demonstrated retrograde flow of contrast into the four individual tendons of the FDL, with observation of a large intertendinous slip between the FHL and FDL on dissection. Another cadaver demonstrated contrast filling in the QP with an associated intertendinous slip between the FHL and QP on dissection. These results indicate that the master knot of Henry (the location in the plantar aspect of the midfoot where the FHL and FDL tendons decussate, with the FDL passing superficially over the FHL) has at least the potential to serve as one source of communication in diabetic foot infections from the medial plantar compartment and FHL to the central and lateral compartments via the FDL and to the rearfoot via the QP.
Corresponding author: Andrew J. Meyr, DPM, Department of Podiatric Surgery, TUSPM Department of Surgery, Temple University School of Podiatric Medicine, 8th at Race St, Philadelphia, PA 19107. (E-mail: email@example.com)