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Hosokawa T, Ikoma K, Kido M, Hara Y, Maki M, Ohashi S, Kubo T. Subcutaneous rupture of the flexor hallucis longus tendon at the musculotendinous junction in a soccer player. J Orthop Sci 2021; 26:311-314. [PMID: 30224230 DOI: 10.1016/j.jos.2018.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 07/13/2018] [Accepted: 08/10/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Toshihiro Hosokawa
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Kazuya Ikoma
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan.
| | - Masamitsu Kido
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Yusuke Hara
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Masahiro Maki
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Suzuyo Ohashi
- Department of Rehabilitation Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Toshikazu Kubo
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
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Sayel FA, Pitakveerakul A, Alshalawi S, Wiewiorski M, Valderrabano V. Neglected Iatrogenic Flexor Hallucis Longus Tendon Rupture After Haglund's Endoscopic Surgery: A Case Report. J Foot Ankle Surg 2020; 59:169-172. [PMID: 31753576 DOI: 10.1053/j.jfas.2019.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 07/08/2019] [Accepted: 07/14/2019] [Indexed: 02/03/2023]
Abstract
Rupture of the flexor hallucis longus (FHL) tendon is a rare condition that can occur with direct or indirect trauma; most of the injuries are complete ruptures resulting from laceration. Endoscopic calcaneoplasty is used for treatment of symptomatic Haglund's deformity, and complications of this procedure are rare. Iatrogenic FHL tendon rupture occurring after endoscopic calcaneoplasty has not been reported previously. This case report presents a rare complication after endoscopic calcaneoplasty and the proper method of treatment.
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Affiliation(s)
- Faisal Al Sayel
- Orthopaedic Fellow, Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland
| | - Akaradech Pitakveerakul
- Orthopaedic Fellow, Department of Orthopaedic Surgery, Sirindhorn Hospital, Bangkok, Thailand
| | - Saud Alshalawi
- Orthopaedic Fellow, Orthopaedic Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Martin Wiewiorski
- Head, Foot & Ankle Unit, Orthopaedic and Trauma Department, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Victor Valderrabano
- Professor, Chairman, Orthopaedic Department, Swiss Ortho Center, Schmerzklinik Basel, Swiss Medical Network, Basel, Switzerland.
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Chun DI, Lee HS, Won SH, Moon SI, Jung KJ, Seo JH, Cho HK, Lee DW, Ryu A, Manggala Y, Kim WJ. Closed atraumatic complete rupture of the flexor halluces longus tendon during forward lunge exercise: A case report. Medicine (Baltimore) 2019; 98:e18409. [PMID: 31852162 PMCID: PMC6922354 DOI: 10.1097/md.0000000000018409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Acute rupture of the flexor halluces longus (FHL) tendon due to trauma or laceration is a well-known phenomenon. Partial rupture of the FHL tendon caused by tendinitis or stenosing tenosynovitis is common in ballet dancers and athletes. However, atraumatic complete rupture of the FHL is rare: as of 2018, only 7 cases of closed atraumatic complete rupture of the FHL tendon have been reported in the literature. Here, we report on a patient who presented with a closed atraumatic complete rupture of the FHL tendon during a forward lunge exercise. PATIENT CONCERNS A 35-year-old female visited the clinic with pain in the plantar medial aspect of the left foot, along with weakness and loss of great toe flexion. The patient had a normal foot structure and no history of trauma or systemic disease. She performed a forward lunge exercise more than 50 times on 1 leg per day, more than once a week to strengthen her leg muscles. She reported that she felt a slight pain in her left, great toe while exercising for 3 weeks prior to her visit. One week prior to presentation, severe pain occurred suddenly when her left hallux dorsiflexed strongly during an anterior lunge exercise motion. DIAGNOSIS Magnetic resonance imaging revealed complete rupture of the FHL tendon near the level of the metatarsal head and neck junction. The lesion was prolonged, with the proximal end displaced to the metatarsal shaft region. INTERVENTIONS Complete rupture of the FHL tendon was treated with a primary suture. OUTCOMES At the 1-year follow-up, active plantar flexion of the interphalangeal joint was possible but joint function had a range of 0° to 25°. Flexion strength was reduced slightly, measuring about 70% when compared to the contralateral side, but flexion strength of the metatarsophalangeal joint was normal. LESSONS We describe an extremely rare case of complete rupture of the FHL tendon at the level of metatarsal head and neck junction. It should be understood that this injury can occur not only in professional athletes but also in the general public, and we recommend educating personal trainers on how to prevent it.
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Affiliation(s)
- Dong Il Chun
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu
| | - Hong Seop Lee
- Department of Foot and Ankle Surgery, Nowon Eulji Medical Center, Eulji University, Hangeulbiseok-ro, Nowon-gu, Seoul
| | - Sung Hun Won
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu
| | - Sang Il Moon
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
| | - Ki Jin Jung
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
| | - Jong Hyun Seo
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu
| | - Hyung Ki Cho
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Seoul, Yongsan-gu
| | - Dhong Won Lee
- Department of Orthopaedic Surgery, Konkuk University Medical Center, Neungdong-ro, Gwangjin-gu, Seoul
| | - Aeli Ryu
- Department of Obstetrics and Gynecology, Soonchunhyang University Hospital Cheonan, Suncheonhyang 6-gil, Dongam-gu, Cheonan, Korea
| | - Yudha Manggala
- Department of Orthopaedic and Traumatology Surgery, Medicine Faculty, Soegijapranata Catholic University, Semarang, Indonesia
| | - Woo Jong Kim
- Department of Orthopaedic Surgery, Soonchunhyang University Hospital Cheonan, Dongam-gu, Cheonan
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Anastasopoulos N, Paraskevas G, Lazaridis N, Natsis K. Reconstruction of Neglected Flexor Hallucis Longus Tendon Rupture: A Case Report. J Foot Ankle Surg 2019; 57:1256-1258. [PMID: 29937339 DOI: 10.1053/j.jfas.2018.03.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Indexed: 02/03/2023]
Abstract
Isolated rupture of the flexor hallucis longus tendon is an unusual injury. We present the case of a neglected flexor hallucis longus tendon closed traumatic rupture at the plantar aspect of the first phalangeal head of the great toe in a middle-age male. The injury occurred while he was dancing. Because end-to-end tendon suture was impossible, the ensuing gap was repaired using a free plantaris tendon graft. We present the operative repair benefit of the flexor hallucis longus tendon rupture to regain the function and strength of the interphalangeal joint of the hallux, avoid extension of the distal phalanx, and maintain the longitudinal arch of the foot.
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Affiliation(s)
- Nikolaos Anastasopoulos
- Orthopedic Surgeon and Assistant Professor, Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George Paraskevas
- Associate Professor, Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Lazaridis
- Lecturer, Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Konstantinos Natsis
- Professor, Department of Anatomy and Surgical Anatomy, Faculty of Health Sciences, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Grady JF, Boumendjel Y, Nguyen NT, Caldwell A. Transplantation with allograft for rupture of the flexor hallucis longus tendon with subsequent longitudinal tear of the flexor digitorum longus tendon at the master knot of Henry: a case report. J Am Podiatr Med Assoc 2016; 104:508-13. [PMID: 25275740 DOI: 10.7547/0003-0538-104.5.508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A rare case of closed complete rupture of the flexor hallucis longus tendon with subsequent longitudinal tear of the flexor digitorum longus tendon is reported in a marathon runner. This is also a first case report of flexor hallucis longus transplant with cadaveric posterior tibial tendon allograft. Two minimal incisions distal and proximal to the malleolus allowed for tunneling with urethral dilators to open the tendon sheath for transplantation, avoiding the need for a large incision. Postoperatively, the patient regained active flexion at the interphalangeal joint of the left hallux. Four months after surgery, full range of motion was observed and dynamometric exam revealed 68% of the strength of the contralateral side. The patient was able to resume competitive running after the surgery and performed well in her age bracket.
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Affiliation(s)
| | | | - Ngan T. Nguyen
- Department of Podiatry, Dr. William M. Scholl College of Podiatric Medicine, North Chicago, IL
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de Souza LJ, Rutledge E. Closed Rupture of the Flexor Hallucis Longus Tendon with Evaluation of the Mechanism of Injury: A Case Report. JBJS Case Connect 2014; 4:e45. [PMID: 29252349 DOI: 10.2106/jbjs.cc.m.00167] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Leo J de Souza
- Department of Orthopaedic Surgery, Hennepin County Medical Center, Suite G2, 701 Park Avenue South, Minneapolis, MN 55415
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Noda D, Yoshimura I, Kanazawa K, Hagio T, Naito M. Subcutaneous rupture of the flexor hallucis longus tendon: a case report. J Foot Ankle Surg 2011; 51:234-6. [PMID: 22153296 DOI: 10.1053/j.jfas.2011.10.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Indexed: 02/03/2023]
Abstract
It is well known that rupture of the flexor hallucis longus tendon can be associated with open injuries and that closed rupture of the flexor hallucis longus tendon is rare. Tendon injuries of the foot can occur secondary to direct, indirect, or repetitive injury. Repetitive tendon injuries can cause tendinitis or stenosing tenosynovitis. Tendinitis is associated with internal tendon injury that can present with tendon thickening, mucinoid degeneration, nodule development, or in situ partial tears. Stenosing tenosynovitis is the development of tendon adhesions within the tendon sheath that interfere with tendon gliding, known as trigger toe. The flexor hallucis longus tendon is susceptible to injury along its entire course. A total of 35 cases of complete or partial closed ruptures of the flexor hallucis longus tendon have been reported. We present the case of complete subcutaneous rupture of the flexor hallucis longus tendon associated with trauma at the proximal phalangeal head.
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Affiliation(s)
- Daisuke Noda
- Department of Orthopaedic Surgery, Fukuoka University School of Medicine, Fukuoka, Japan.
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Thakur N, Leswick DA. Case of the month #167: flexor hallicus longus tendon tear distal to the master knot of Henry. Can Assoc Radiol J 2011; 62:154-7. [PMID: 21501796 DOI: 10.1016/j.carj.2009.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2009] [Revised: 12/04/2009] [Accepted: 12/11/2009] [Indexed: 11/30/2022] Open
Affiliation(s)
- Nathan Thakur
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
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Abstract
Acute injuries of the Achilles tendon are common among athletes and non-athletes alike. Injuries of other posterior calf muscles are far less common but should be considered in the differential, to ensure proper diagnosis and treatment of patients with calf injuries. This article focuses on these calf injuries, including injuries of the gastrocnemius, plantaris, soleus, and flexor hallucis longus, which may occasionally be mistaken for Achilles tendon disorders.
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Sizer PS, Phelps V, James R, Matthijs O. Diagnosis and management of the painful ankle/foot part 1: clinical anatomy and pathomechanics. Pain Pract 2007; 3:238-62. [PMID: 17147674 DOI: 10.1046/j.1533-2500.2003.03029.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Distinctive anatomical features can be witnessed in the ankle/foot complex, affording specific pathological conditions. Disorders of the ankle/foot complex are multifactoral and features in both the clinical anatomy and biomechanics contribute to the development of ankle/foot pain. The superior tibiofibular, distal tibiofibular, talocrural, subtalar, and midtarsal joint systems must all participate in function of the ankle/foot complex, as each biomechanically contributes to functional movements and clinical disorders witnessed in the lower extremity. A clinician's ability to effectively evaluate, diagnose, and treat the distal lower extremity is largely reliant upon a foundational understanding of the clinical anatomy and biomechanics of this complex complex. Thus, clinicians are encouraged to consider these distinctions when examining and diagnosing disorders of the ankle/foot.
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Affiliation(s)
- Phillip S Sizer
- Texas Tech University Health Science Center, School of Allied Health, Doctorate of Science Program in Physical Therapy, Lubbock TX 79430, USA
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Herbst SA, Miller SD. Transection of the medial plantar nerve and hallux cock-up deformity after flexor hallucis longus tendon transfer for Achilles tendinitis: case report. Foot Ankle Int 2006; 27:639-41. [PMID: 16919220 DOI: 10.1177/107110070602700814] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Stephen A Herbst
- Department of Orthopaedics, Union Memorial Hospital, Baltimore, MD 21218, USA
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Michelson J, Dunn L. Tenosynovitis of the flexor hallucis longus: a clinical study of the spectrum of presentation and treatment. Foot Ankle Int 2005; 26:291-303. [PMID: 15829213 DOI: 10.1177/107110070502600405] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Symptoms associated with flexor hallucis longus (FHL) pathology can manifest themselves anywhere along its length from the posterior leg to the plantar foot and the hallux. This study describes the spectrum of clinical presentations seen with FHL pathology, illustrates the relevant physical examination findings, and outlines a treatment approach. MATERIALS Computerized medical data was prospectively collected on 81 patients treated between January, 1997 and March, 2002. The 55 females and 26 males had an average age of 38.3 years, with a mean follow-up of 21.3 months. Forty-five of 81 had previous therapy that failed, usually for "plantar fasciitis." Twenty-seven were active athletically and 24 related the onset of symptoms to a specific traumatic episode. Pain was located at the posteromedial ankle in 40, plantar heel in 23, plantar midfoot in 22, and multiple locations in 16. All patients had tenderness of the FHL. Restriction of FHL excursion was demonstrated in 30 patients by limited hallux metatarsophalangeal joint dorsiflexion when the ankle was dorsiflexed ("FHL stretch test"). Thirty-four patients had magnetic resonance imaging of the FHL, 28 (82%) of which were positive for synovitis of the FHL. Treatment included an FHL stretching program, short-term immobilization, and operative decompression and synovectomy in patients for whom nonoperative treatment failed. RESULTS Of the 58 patients treated nonoperatively, 37 (64%) had successful results. Twenty-three patients had surgery, 20 at the posterior ankle fibro-osseous tunnel, and three in the sesamoid region. All patients treated operatively had successful outcomes. A subset of 10 patients had hallux rigidus symptoms without significant osteophyte formation. All 10 obtained successful results with treatment directed at restoring normal FHL excursion (nine nonoperatively, one by FHL release). This suggests that limited FHL excursion may be an etiology for the development of hallux rigidus. CONCLUSIONS Clinical syndromes related to the FHL are more frequent than previously reported. The close relationship of the FHL to commonly injured structures (such as the plantar fascia) contributes to significant delays in effective treatment.
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Affiliation(s)
- James Michelson
- Department of Orthopaedics, University of Vermont, Stafford 428B, Burlington, VT 05405, USA.
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Abstract
Conventional radiographs in conjunction with clinical examination remains the primary method for evaluating the acute athletic injury. In most cases, suspected acute tendon and ligament injuries are initially treated based on physical examination. Magnetic resonance (MR) imaging, with its multiplanar capability and superb soft tissue contrast, is quickly becoming the method of choice for evaluating chronic foot and ankle pain and further defining the extent of tendon and ligament injuries. This article reviews the common acute and chronic (overuse) foot and ankle athletic injuries with an emphasis on imaging characteristics.
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Affiliation(s)
- William R Dunfee
- Radiology Associates of Tarrant County, Fort Worth, TX 76104, USA
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Abstract
Sonography of the foot and ankle offers many advantages. Currently, sonographic evaluation rivals or exceeds MR imaging for evaluation of tendons, joint and bursal pathology, and specific soft tissue pathology. The advantages of sonographic evaluation provide a strong impetus for applying this modality to imaging of foot and ankle pathology. Those who accept the challenge will have an expanded repertoire to offer in the pursuit of efficient and effective patient care.
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Affiliation(s)
- D P Fessell
- Department of Radiology, University of Michigan Medical Center, Ann Arbor, USA
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