Adductor Hallucis: Difference between revisions

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== Description  ==
== Description  ==
Adductor Hallucis muscle is an intrinsic two-headed muscle in the sole of the foot. It
Adductor hallucis muscle is an intrinsic two-headed muscle in the sole of the foot. It is 1 of 3 muscles in the third layer of plantar foot muscles. The other muscles of the third layer of plantar foot muscles are [[Flexor Hallucis Brevis|flexor hallucis brevis]] and flexor digiti minimi brevis<ref name=":0">Moore KL, Dalley AF, R. AAM, Moore KL. lower limb. In: Moore clinically oriented anatomy. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. p. 610–5.</ref>.
[[File:Adductor Hallucis.png|center|thumb]]


=== Origin ===
=== Origin ===
Muscle originates by two muscular heads, the transverse and oblique heads. The oblique head originates from the base of the second, third and forth metatarsals. The transverse head originates from the deep transverse metatarsal ligaments and the plantar metatarsal ligaments.  
Muscle originates by two muscular heads, the transverse and oblique heads. The oblique head originates from the bases of the second, third and forth metatarsals. The transverse head originates from the plantar ligaments of metatarsophalangeal (MTP) joints<ref name=":0" />.  


=== Insertion  ===
=== Insertion  ===
Adductor hallucis muscle inserts into the lateral side of base of proximal phalanx and sesamoid bone associated with the Flexor Hallucis Brevis tendon  
The two heads of the adductor hallucis join together before inserting distally on the lateral side of the base of the proximal phalanx of the first digit<ref name=":0" />. The distal attachment point joins with the flexor hallucis brevis tendon on the fibular sesamoid as well<ref name=":1">Owens S, Thordarson DB. The adductor hallucis revisited. Foot Ankle Int. 2001 Mar;22(3):186-91.</ref>.


=== Nerve ===
=== Nerve ===
The deep branch of the lateral Plantar nerve from the tibial nerve (S2, S3)  
The deep branch of the [[Lateral Plantar Nerve|lateral plantar nerve]] (S2, S3) from the [[Tibial Nerve|tibial nerve]].


=== Artery ===
=== Artery ===
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== Function ==
== Function ==
Adducts and flexes the great toe at the metatarsal phalangeal joint. Supports the transverse arch  
Adducts and flexes the great toe at the metatarsophalangeal joint. Supports the transverse arch.
 
It may be most active during push-off  of the gait cycle by stabilizing the transverse arch of the foot and metatarsal heads<ref name=":0" />. 


== Clinical relevance  ==
== Clinical relevance  ==
Supports the longitudinal and transverse arch of the foot. A key intrinsic muscle of the foot.  
Supports the longitudinal and transverse arch of the foot. A key intrinsic muscle of the foot.  
Due to the pull on the lateral aspect of the first digit, the adductor hallucis may contribute to [[Hallux Valgus|hallux valgus]] deformities<ref name=":1" />. Surgeons have reported that a full surgical release of the distal tendon of the adductor hallucis during bunionectomies can lead to hallux varus<ref name=":1" />.   


== Assessment  ==
== Assessment  ==
Adductor hallucis muscle testing can be done by resisting flexion and adduction of the first digit.


== Treatment  ==
== Treatment  ==
A traumatic rupture of the adductor hallucis is uncommon but can also lead to hallux varus deformities. Barp et al reported good surgical outcome in a case study of a 33 year-old male who underwent surgical fixation of the adductor hallucis tendon following a traumatic rupture while pivoting on a barefoot<ref>Barp EA, Temple EW, Hall JL, Smith HL. Treatment of Hallux Varus After Traumatic Adductor Hallucis Tendon Rupture. J Foot Ankle Surg. 2018 Mar-Apr;57(2):418-420.</ref>. Other treatments of the adductor hallucis are not well documented.


== Resources  ==
== Resources  ==

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Description[edit | edit source]

Adductor hallucis muscle is an intrinsic two-headed muscle in the sole of the foot. It is 1 of 3 muscles in the third layer of plantar foot muscles. The other muscles of the third layer of plantar foot muscles are flexor hallucis brevis and flexor digiti minimi brevis[1].

Adductor Hallucis.png

Origin[edit | edit source]

Muscle originates by two muscular heads, the transverse and oblique heads. The oblique head originates from the bases of the second, third and forth metatarsals. The transverse head originates from the plantar ligaments of metatarsophalangeal (MTP) joints[1].

Insertion[edit | edit source]

The two heads of the adductor hallucis join together before inserting distally on the lateral side of the base of the proximal phalanx of the first digit[1]. The distal attachment point joins with the flexor hallucis brevis tendon on the fibular sesamoid as well[2].

Nerve[edit | edit source]

The deep branch of the lateral plantar nerve (S2, S3) from the tibial nerve.

Artery[edit | edit source]

Lateral Plantar Artery

Function[edit | edit source]

Adducts and flexes the great toe at the metatarsophalangeal joint. Supports the transverse arch.

It may be most active during push-off of the gait cycle by stabilizing the transverse arch of the foot and metatarsal heads[1].

Clinical relevance[edit | edit source]

Supports the longitudinal and transverse arch of the foot. A key intrinsic muscle of the foot.

Due to the pull on the lateral aspect of the first digit, the adductor hallucis may contribute to hallux valgus deformities[2]. Surgeons have reported that a full surgical release of the distal tendon of the adductor hallucis during bunionectomies can lead to hallux varus[2].

Assessment[edit | edit source]

Adductor hallucis muscle testing can be done by resisting flexion and adduction of the first digit.

Treatment[edit | edit source]

A traumatic rupture of the adductor hallucis is uncommon but can also lead to hallux varus deformities. Barp et al reported good surgical outcome in a case study of a 33 year-old male who underwent surgical fixation of the adductor hallucis tendon following a traumatic rupture while pivoting on a barefoot[3]. Other treatments of the adductor hallucis are not well documented.

Resources[edit | edit source]

  1. 1.0 1.1 1.2 1.3 Moore KL, Dalley AF, R. AAM, Moore KL. lower limb. In: Moore clinically oriented anatomy. Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams & Wilkins; 2014. p. 610–5.
  2. 2.0 2.1 2.2 Owens S, Thordarson DB. The adductor hallucis revisited. Foot Ankle Int. 2001 Mar;22(3):186-91.
  3. Barp EA, Temple EW, Hall JL, Smith HL. Treatment of Hallux Varus After Traumatic Adductor Hallucis Tendon Rupture. J Foot Ankle Surg. 2018 Mar-Apr;57(2):418-420.