Flexor hallucis longus: Difference between revisions

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Flexor hallucis longus is a powerful muscle located on the posterior aspect of the fibular below the deep fascia of the calf. In its own synovial sheath, the tendon passes downwards, deep to the flexor retinaculum, crossing the posterior ankle joint, lateral to [[Flexor digitorum longus|flexor digitorum longus]]. The tendon wraps around the lower end of the of the tibia, the back of the talus, and the inferior surface of the sustentaculum tali, where its passes through a fibrous, synovial-lined tunnel.<ref name="pala">Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th ed. London, United Kingdom: Churchill Livingstone; 2012.</ref>  
Flexor hallucis longus is a powerful muscle located on the posterior aspect of the fibular below the deep fascia of the calf. In its own synovial sheath, the tendon passes downwards, deep to the flexor retinaculum, crossing the posterior ankle joint, lateral to [[Flexor digitorum longus|flexor digitorum longus]]. The tendon wraps around the lower end of the of the tibia, the back of the talus, and the inferior surface of the sustentaculum tali, where its passes through a fibrous, synovial-lined tunnel.<ref name="pala">Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th ed. London, United Kingdom: Churchill Livingstone; 2012.</ref>  


As the tendon enters into the sole of the foot it lies superficial to the spring ligament passing forward deep to the tendon of flexor digitorum longus. It then enters teh fibrous sheath of the great toe passing between the two seasmoid bones to insert at the base of the disatal phalanx.<ref name="pala" />
As the tendon enters into the sole of the foot it lies superficial to the spring ligament passing forward deep to the tendon of flexor digitorum longus. It then enters teh fibrous sheath of the great toe passing between the two seasmoid bones to insert at the base of the distal phalanx.<ref name="pala" />  


=== Origin  ===
=== Origin  ===
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=== Artery  ===
=== Artery  ===


Peroneal artery<ref name="salad">Saladin K. Anatomy &amp;amp;amp;amp;amp; physiology: The Unity of Form and Function. 5th ed. New York: McGraw-Hill; 2010.</ref>
Peroneal artery<ref name="salad">Saladin K. Anatomy &amp;amp;amp;amp;amp;amp; physiology: The Unity of Form and Function. 5th ed. New York: McGraw-Hill; 2010.</ref>


== Function  ==
== Function  ==

Revision as of 19:49, 11 January 2017

Description[edit | edit source]

FHL1.png

Flexor hallucis longus is a powerful muscle located on the posterior aspect of the fibular below the deep fascia of the calf. In its own synovial sheath, the tendon passes downwards, deep to the flexor retinaculum, crossing the posterior ankle joint, lateral to flexor digitorum longus. The tendon wraps around the lower end of the of the tibia, the back of the talus, and the inferior surface of the sustentaculum tali, where its passes through a fibrous, synovial-lined tunnel.[1]

As the tendon enters into the sole of the foot it lies superficial to the spring ligament passing forward deep to the tendon of flexor digitorum longus. It then enters teh fibrous sheath of the great toe passing between the two seasmoid bones to insert at the base of the distal phalanx.[1]

Origin[edit | edit source]

Lower two-thirds of posterior fibula.

Insertion[edit | edit source]

Plantar surface at the base of the first distal phalanx 

Nerve[edit | edit source]

Branch of the tibial nerve (root S1 and S2).

Cutaneous supply from root S2.

Artery[edit | edit source]

Peroneal artery[2]

Function[edit | edit source]

Flexes the phalanx of the great toe as the foot is raised from the ground. Additionally stabilises the first metatarsal head and keeps distal pad of the great toe in contact with ground in toe-off and when on tip-toe.[2]

Clinical relevance[edit | edit source]

Fractures of the sustentaculum tali can cause entrapment of the flexor hallucis longus or flexor digitorum longus tendons amongst other abnormalities that may indicate reconstructive surgery. Post-operative management includes the use of a lower leg splint for 5-7 days, partial weight-bearing with 20 kg for 6-8 weeks in the patient's own footwear, early range of motion exercises of the ankle, subtalar and mid-tarsal joints. Outcomes are generally good with those sustaining isolated fractures performing better.[3]

Assessment[edit | edit source]

Palpation[edit | edit source]

It is near impossible to locate the origin due to it's depth to the soleus muscle. The insertional tendon is also deep but can be identified as it passes alongside the sustentaculum tali.

Power[edit | edit source]

Length[edit | edit source]

Treatment[edit | edit source]

Strengthening[edit | edit source]

Stretching[edit | edit source]

Manual techniques[edit | edit source]

Resources[edit | edit source]


FHL2.jpg FDL2.png Footflexor.png File:FDL4.JPG FDL5.png

See also[edit | edit source]

Recent Related Research (from Pubmed)[edit | edit source]

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References[edit | edit source]

  1. 1.0 1.1 Palastanga N, Soames R. Anatomy and Human Movement: Structure and Function. 6th ed. London, United Kingdom: Churchill Livingstone; 2012.
  2. 2.0 2.1 Saladin K. Anatomy &amp;amp;amp;amp;amp; physiology: The Unity of Form and Function. 5th ed. New York: McGraw-Hill; 2010.
  3. Dürr C, Zwipp H, Rammelt S. Fractures of the sustentaculum tali. Operative Orthopädie und Traumatologie. 2013 Dec;25(6):569–78.