دانلود رایگان مقاله مطالعه تشریحی خمیدگی انگشت پا توسط فلکسور عضله بلند hallucis

Abstract

Because connections exist between the flexor hallucis longus (FHL) and flexor digitorum longus (FDL), the FHL is surmised to exert a flexion action on the lesser toes, but this has not been studied quantitatively. The objectives of this study have thus been to clarify the types of FHL and FDL connections and branching, and to deduce the toe flexion actions of the FHL. One hundred legs from 55 cadavers were used for the study, with FHLs and FDLs harvested from the plantar aspect of the foot, and connections and branches classified. Image-analysis software was then used to analyze cross-sectional areas (CSAs) of each tendon, and the proportion of FHL was calculated in relation to flexor tendons of each toe. Type I (single slip from FHL to FDL tendon) was seen in 86 legs (86%), Type II (crossed connection) in 3 legs (3%), and Type III (single slip from FDL to FHL tendon) or Type IV (no connection between muscles) in 0 legs (0%). In addition, Type V (double slip from FHL to FDL tendon) was seen in 11 legs (11%), representing a new type not recorded in previous classifications. In terms of the various flexor tendons, the proportion of FHL showing tendons to toes 2 and 3 was high, at approximately 50–70%. Consequently, considering the branching type and proportion of CSA, the FHL was conjectured to not only act to flex the hallux, but also play a significant role in the flexion of toes 2 and 3. These results offer useful information for future clarification of the functional roles of tendinous slips from the FHL.

3. Results

Type I was found in 86 legs (86%), Type II in 3 legs (3%) and Types III and IV in 0 legs (0%). Type V (double slip from FHL to FDL tendon) was seen in 11 legs (11%), representing a new type not recorded in previous classifications (O’Sullivan et al., 2005; Plaass et al., 2013) (Fig. 5). Type A accounted for 38 cases (38%), Type B for 54 cases (54%) and Type C for 8 cases (8%). Among Type A and B cases, branching was to the lumbricalis pedis muscle in 17 cases (17%). No Type D cases were identified (Fig. 6). No significant sex-based differences were apparent. In differences between left and right legs, both legs were able to be measured for 45 cadavers (54 legs from 27 male cadavers and 36 legs from 18 female cadavers). No significant differences were thus evident (Table 1). The proportion of FHL branching to each toe is shown in Table 2. The proportion of FHL with respect to flexor tendons to each toe is shown in Table 3. Among the proportions of FHL with respect to the various flexor tendons, the proportion of FHL to toes 2 and 3 was high, approximately 50–70%.