Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer.
BACKGROUND
Achilles tendinosis and chronic Achilles tendon ruptures are relatively frequently encountered by orthopaedic surgeons. One treatment for patients who fail to respond to conservative management involves augmentation of the repair with transfer of the flexor hallucis longus (FHL), using either a single-incision or double-incision technique. Despite the frequency of this procedure, little is known about the associated donor morbidity. We report the effects of the single-incision technique on hallux function.


METHODS
We retrospectively reviewed 48 patients who underwent a single-incision FHL tendon transfer for chronic Achilles tendon rupture or Achilles tendinosis. Twenty-two patients (mean followup, 28 months) completed the study. The average age was 56 years. Outcome measures included the American Orthopaedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal (MTP) joint and interphalangeal (IP) joint scores, the Health Related Quality of Life Measures Short Form (SF-36). Also, the average of two pedobarographic measurements of both feet and strength testing of the FHL of both feet were recorded.


RESULTS
Decreased distal phalangeal pressure and FHL weakness were demonstrated (p < 0.05). No difference was noted in plantar pressure of the first or second metatarsal head. The high score on the AOFAS hallux MTP-IP scale demonstrated improved patient forefoot function after FHL transfer through a single-incision technique.


CONCLUSIONS
Flexor hallucis longus tendon transfer using a single-incision technique results in decreased flexion power at the IP joint as demonstrated by decreased distal phalangeal pulp pressure; however, this appears to be a laboratory finding as patient function remains high.
Richardson
David R
DR
University of Tennessee, Campbell Clinic, Orthopaedic Surgery, 1211 Union Avenue Suite 510, Memphis, TN 38103, USA. drrichardson@campbellclinic.com
Willers
Jeffrey
J
Cohen
Bruce E
BE
Davis
W Hodges
WH
Jones
Carroll P
CP
Anderson
Robert B
RB
D000125:Achilles Tendon / Q000293:injuries*; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000503:physiopathology*; D008875:Middle Aged; D053580:Muscle Strength / Q000502:physiology; D012189:Retrospective Studies; D012421:Rupture; D052256:Tendinopathy / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013709:Tendon Transfer / Q000009:adverse effects* / Q000379:methods*; D014033:Toe Joint / Q000503:physiopathology*; D016896:Treatment Outcome; D016474:Weight-Bearing / Q000502:physiology