Abstract
Hallux valgus, limitus, and rigidus are conditions affecting the first metatarsophalangeal
joint that can be treated by arthroplasty. Excessive arthroplasty can compromise the
insertion of the tendons at the base of the proximal phalanx of the hallux, leading
to first metatarsophalangeal joint plantarflexion weakness, cock-up toe deformity,
and altered forefoot loading. The present study investigated the anatomic length of
insertion of the medial and lateral flexor hallucis brevis, extensor hallucis brevis,
abductor hallucis, and adductor hallucis tendons into the base of the hallux proximal
phalanx and the amount of bone that can be safely resected without compromising the
insertional limits. A total of 43 specimens (22 right and 21 left) from 22 embalmed
cadavers (11 male and 11 female) were dissected. The insertion lengths of the 5 tendons
were measured, along with the dimensions of the hallux proximal phalanx. No statistically
significant differences were found in any proximal phalanx measurements or tendon
insertion lengths according to side (p > .05). Significant differences were found between the genders in most dimensions
of the hallux proximal phalanx (p < .05). The medial insertion site, where the medial flexor brevis tendon and distal
abductor hallucis muscle join, was longer than the lateral site (p < .001). To preserve the tendon’s insertion, hallux proximal phalanx resection should
not exceed 3 mm. Resection of the tendons is ensured by removal of more than 7.88
mm and 9.37 mm in females and males, respectively. When performing hallux arthroplasty
of the first metatarsophalangeal joint, we recommend calculating the length of the
tendon insertions, instead of the length of the hallux proximal phalanx.
Level of Clinical Evidence
Keywords
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Article info
Publication history
Published online: July 16, 2012
Footnotes
Financial Disclosure: None reported.
Conflict of Interest: None reported.
Identification
Copyright
© 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.
