Case Report| Volume 58, ISSUE 4, P766-770, July 2019

Download started.


Arthroscopic Lengthening of the Flexor Hallucis Longus Tendon to Correct Hallux Flexion Deformity

Published:April 06, 2019DOI:


      Contracture of the flexor hallucis longus (FHL) tendon is one of the most common factors leading to hallux flexion deformity. Few cases treated by arthroscopic technology have been reported. In this article, we perform a new method to lengthen the FHL tendon under an arthroscope. We present a case of 1 patient treated with this technique and followed for 2 years. The appearance of his halluces remarkably improved at the follow-up visits, and movement was refined simultaneously. From the satisfactory effect of this operation, lengthening the FHL tendon under arthroscope is an effective method to correct flexion deformity of the hallux with minimal incisions. This technique also provides an innovative application of minimally invasive surgeries to treat clinically infrequent diseases.

      Level of Clinical Evidence


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Foot and Ankle Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sassu P
        • Acland RD
        • Salgado CJ
        • Mardini S
        • Ozyurekoglu T
        Anatomy and vascularization of the flexor hallucis longus muscle and its implication in free fibula flap transfer: an anatomical study.
        Ann Plast Surg. 2010; 64: 233-237
        • Kadel NJ
        • Donaldson-Fletcher EA
        • Hansen ST
        • Sangeorzan BJ
        Alternative to the modified jones procedure: outcomes of the flexor hallucis longus (FHL) tendon transfer procedure for correction of clawed hallux.
        Foot Ankle Int. 2005; 26: 1021-1026
        • Jahss EBMH
        • Jahss MH
        Disorders of the Foot & Ankle: Medical and Surgical Management.
        2nd ed. Saunders, Philadelphia1991
        • Lui TH
        Flexor hallucis longus tendon to extensor hallucis longus tendon transfer for flexible hallux claw toe deformity: a minimally invasive approach.
        Foot Ankle Int. 2013; 34: 303-306
        • Pollard JP
        • Morrison PJ
        Flexor tenotomy in the treatment of curly toes.
        Proc R Soc Med. 1975; 68: 480-481
        • Lountzis N
        • Parenti J
        • Cush G
        • Urick M
        • Miller IO
        Percutaneous flexor tenotomy-office procedure for diabetic toe ulcerations.
        Wounds. 2007; 19: 64-68
        • van Netten JJ
        • Bril A
        • van Baal JG
        The effect of flexor tenotomy on healing and prevention of neuropathic diabetic foot ulcers on the distal end of the toe.
        J Foot Ankle Res. 2013; 6: 3
        • van Dijk CN
        • Scholten PE
        • Krips R
        A 2-portal endoscopic approach for diagnosis and treatment of posterior ankle pathology.
        Arthroscopy. 2000; 16: 871-876
        • Kim SH
        • Ha KI
        The SMC knot—a new slip knot with locking mechanism.
        Arthroscopy. 2000; 16: 563-565
        • Smyth NA
        • Zwiers R
        • Wiegerinck JI
        • Hannon CP
        • Murawski CD
        • van Dijk CN
        • Kennedy JG
        Posterior hindfoot arthroscopy: a review.
        Am J Sports Med. 2014; 42: 225-234
        • Boffeli TJ
        • Collier RC
        Minimally invasive soft tissue release of foot and ankle contracture secondary to stroke.
        J Foot Ankle Surg. 2014; 53: 369-375
        • Kim HT
        • Oh JS
        • Lee JS
        • Lee TH
        Z-lengthening of the Achilles tendon with transverse skin incision.
        Clin Orthop Surg. 2014; 6: 208-215
        • Lee JH
        • Kim YJ
        • Baek JH
        • Kim DH
        Z-plasty of the flexor hallucis longus tendon at tarsal tunnel for checkrein deformity.
        J Orthop Surg (Hong Kong). 2016; 24: 354-357
        • Keeling JJ
        • Guyton GP
        Endoscopic flexor hallucis longus decompression: a cadaver study.
        Foot Ankle Int. 2007; 28: 810-814
        • Takakura Y
        • Yajima H
        • Tanaka Y
        • Komeda T
        • Tamai S
        Treatment of extrinsic flexion deformity of the toes associated with previous removal of a vascularized fibular graft.
        J Bone Joint Surg Am. 2000; 82: 58-61
        • Lombardi CM
        • Silhanek AD
        • Connolly FG
        Modified arthroscopic excision of the symptomatic os trigonum and release of the flexor hallucis longus tendon: operative technique and case study.
        J Foot Ankle Surg. 1999; 38: 347-351