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- Author or Editor: Fermín Viejo Tirado x
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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)
We describe a simplified capsular interpositional technique for the Keller bunionectomy that uses a Kirschner wire to interpose the capsule into the first metatarsophalangeal joint without requiring sutures. The capsule acts as a biologic spacer in the first metatarsophalangeal joint, allowing for fibrosis to fill the void created, with the Kirschner wire maintaining the distance between the metatarsal head and the stump of the proximal phalanx. This creation of a nonpainful pseudarthrosis prevents shortening of the hallux and retraction of the base of the proximal phalanx on the metatarsal head.
Background: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw or hammer toe deformities. In contrast, a search of the literature revealed no previous reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions. We performed a cadaver 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.
Methods: Transposition of the flexor digitorum brevis tendon was attempted in 180 toes of cadaver feet: 45 second toes, 45 third toes, 45 fourth toes, and 45 fifth toes.
Results: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes and in 42 (93.3%) of the fifth toes. In the three remaining fifth toes (6.7%), the flexor digitorum brevis tendon was absent, a known anatomical variation.
Conclusions: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for correction of claw or hammer toe deformities, especially in the second, third, and fourth toes. The transverse aponeurotic fibers originating from the extensor digitorum longus impede the transfer of the flexor digitorum brevis tendon, and meticulous excision of these fibers is essential to the success of the procedure. (J Am Podiatr Med Assoc 98(1): 27–35, 2008)
