Background
An Akin osteotomy is commonly performed to correct hallux valgus interphalangeus. The flexor hallucis longus (FHL) tendon passing plantar to the proximal phalanx is at risk when performing this osteotomy. We describe a method of assessing the integrity of the FHL intraoperatively.
Technique
After the Akin osteotomy has been stabilised, the foot is dorsiflexed passively while observing whether there is reciprocal toe plantarflexion. The presence of this tenodesis effect of the FHL suggests integrity. Conversely, if this is not seen, further exploration of the FHL is indicated.
Discussion
When lacerations occur distal to the knot of Henry, the FHL is unable to function as a flexor.1 It also has a role in maintaining the medial longitudinal arch of the foot. Failure to reconstruct acutely may result in unbalanced extension of the toe and development of a flatfoot deformity.2
Recognition of a FHL injury intraoperatively is not obvious and this is often picked up later in the rehabilitation period. We have described a simple intraoperative test to help identify a possible injury to the FHL, which would lead to immediate reconstruction if present and therefore reduced morbidity.
References
- 1.LaRue BG, Anctil EP. Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons. Foot Ankle Int 2006; : 528–532. [DOI] [PubMed] [Google Scholar]
- 2.Lee HS, Kim JS, Park SS et al. Treatment of checkrein deformity of the hallux. J Bone Joint Surg Br 2008; : 1,055–1,058. [DOI] [PubMed] [Google Scholar]