An anatomic study of the quadratus plantae in relation to tendinous slips of the flexor hallucis longus for gait analysis

Abstract

The aim of this study was to demonstrate the morphology of the quadratus plantae (QP) in relation to the tendinous slips of the flexor hallucis longus (FHL) and their surrounding structures, thereby providing data to understand function of the QP during gait, and for analyzing the movements of the foot and designing postoperative rehabilitation programs. The QP was investigated in 50 specimens of embalmed adult cadavers. The QP inserted into the tendon of the flexor digitorum longus (FDL) and the tendinous slips of the FHL in 96%, and only to the tendon of the FDL in 4%. The tendinous slip of the FHL targeted the tendon for the second toe in 4 of the 50 specimens (8%). The tendinous slip divided into two separate slips to the tendons for the second and third toes in 32 specimens (64%), and for the second, third, and fourth toes in 14 specimens (28%). Thus, the tendon and tendinous slips of the FHL may distribute the load of the great toe to the second toe to the third or fourth toe in the forefoot, especially during toe-off. In addition, the main attachment of the QP to the tendinous slips of the FHL may provide more efficient control of the long flexor tendons in comparison with that of the QP to the tendon of the FDL.

Anatomical Variations of the Flexor Hallucis Longus and Flexor Digitorum Longus in the Chiasma Plantare

“…The fibers from the QP form the central part, the FHL fibers the dorsal, and the FDL fibers the plantar part, before fusion to a solid single tendon. In contrast to previous studies, 13 the QP targeted all lesser toes.…”

The Tendinous Slip of the Flexor Digitorum Longus for the Great Toe: An Anatomic Variation

“…In the previous studies, the tendinous slip of the FHL constituted the long flexor tendon only for the second toe in 8~41.2%; it developed into two slips to the tendons for the second and third toes in 47.1~64% and into three slips to the tendons for the second, third, and fourth toes in 7~ 28% [3,4,[16][17][18]. Thus, it seems that the tendinous slip of the FHL is not a rare variation.…”

“…64 Ju-Young Lee, Mi-Sun Hur during toe-off, increasing the weight-bearing area in the forefoot [18]. In addition, a connection between the FHL and FDL tendons might contribute to residual function of the lesser toes after transfer of the FHL tendon [4].…”

New insights into the origin of the lumbrical muscles of the foot: tendinous slip of the flexor hallucis longus muscle

“…This implies that the attachment of the lumbricals to the tendinous slip of the FHL is important for foot movements. Hur et al (2011) [4] reported that the tendinous slip of the FHL targeted the tendon only for the second toe in 8 % of cases, for the second and third toes in 64 %, and for the second, third, and fourth toes in 28 %. However, the extension of the tendinous slip of the FHL must be investigated in order to observe the origin of the lumbricals, as in the present study.…”

“…However, it has also been demonstrated that the tendinous slip of the flexor hallucis longus muscle (FHL) divides into several slips, which form the long flexor tendons with the tendons of the FDL [4]. Thus, the question has arisen as to whether the lumbricals arise only from the tendon of the FDL or from both the tendinous slip of the FHL and the tendon of the FDL.…”