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Surgical and Radiologic Anatomy

, Volume 41, Issue 7, pp 775–784 | Cite as

Anatomic and histological analyses of chiasma plantare and long flexor tendons of the foot on human fetuses

  • Özlem ElvanEmail author
  • Orhan Beger
  • Meryem İlkay Karagül
  • Deniz Uzmansel
  • Necat Şakir Yılmaz
  • Zeliha Kurtoğlu Olgunus
Original Article
  • 115 Downloads

Abstract

Purpose

The aim of present study was to reveal slip transfers related to flexor hallucis longus (FHL) and flexor digitorum longus (FDL) by dissection and to investigate detailed structure of chiasma plantare composed of FHL–FDL tendons and quadratus plantae (QP), with precise composition of the long flexor tendons of lesser toes by histological sections in human fetuses.

Method

Slip transfers related to FHL and FDL tendons were identified and the related morphometric measurements were taken with dissection in 28 formalin-fixed fetuses (25–40 weeks). Composition and restoration of chiasma plantare and long flexor tendons of lesser toes were traced histological by analyzing movements of the tissues on the sequential coronal sections in five fetuses in the third trimester. The numbers of layers constituting chiasma plantare and the muscles that formed layers were specified. Each of two to five flexor tendons arising from the chiasma plantare was analyzed regarding its formation and contribution of FHL slip.

Results

Slip transfers were found as FHL slip in 86% and cross-connections in 14%. The ratios of the slip width to that of FHL and FDL tendons were found higher than in adult literature. Variance in the involvement of slip to FDL and QP, formation and layering of chiasma plantare and formation of long flexor tendons from chiasma plantare were revealed and great similarities were found with data from dissection of adult in literature.

Conclusion

Slip transfers between FHL and FDL tendons, and layering properties of chiasma plantare were largely finalized during intrauterine period, while structural changes in slip seem to continue in the later stages of life, possibly by the effects of growth and usage of the extremity. In addition to individual variations, investigating the contribution of FHL slip, FDL and QP to long flexor tendons by different methods in literature is also suggested to be responsible for some diversities of our histological study.

Keywords

Chiasma plantare Long flexor tendons Flexor hallucis longus Flexor digitorum longus Quadratus plantae Fetus Slip 

Notes

Author contributions

Ö Elvan: project development, data management, data analysis, manuscript writing, editing. O Beger: project development, data management, data analysis. Mİ Karagül: data management, data analysis, manuscript writing. D Uzmansel: project development, data analysis, editing. NŞ Yılmaz: data management, data analysis, editing. Z Kurtoğlu Olgunus: project development, data analysis, manuscript writing, editing.

Compliance with ethical standards

Conflict of interest

Authors declared no conflict of interest.

References

  1. 1.
    Beger O, Elvan Ö, Keskinbora M, Ün B, Uzmansel D, Kurtoğlu Z (2018) Anatomy of master knot of Henry: a morphometric study on cadavers. Acta Orthop Traumatol Turc 52(2):134–142CrossRefGoogle Scholar
  2. 2.
    Chadwick C, Whitehouse SL, Saxby TS (2015) Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction. Bone Joint J 97:346–352CrossRefGoogle Scholar
  3. 3.
    Edama M, Kubo M, Onishi H et al (2016) Anatomical study of toe flexion by flexor hallucis longus. Ann Anat 204:80–85CrossRefGoogle Scholar
  4. 4.
    Handelsman JE, Weinberg J, Corso S (2007) Management of long toe flexor spasticity in the equinus foot in cerebral palsy. J Pediatr Orthop B 16(3):185–188CrossRefGoogle Scholar
  5. 5.
    Herring JA (2013) Tachdjian’s pediatric orthopaedics e-book: from the Texas Scottish Rite Hospital for Children. Elsevier Health Sciences, AmsterdamGoogle Scholar
  6. 6.
    Hunt KJ, Cohen BE, Davis WH, Anderson RB, Jones CP (2015) Surgical treatment of insertional achilles tendinopathy with or without flexor hallucis longus tendon transfer: a prospective, randomized study. Foot Ankle Int 36:998–1005CrossRefGoogle Scholar
  7. 7.
    Hur MS, Kim JH, Gil YC, Kim HJ, Lee KS (2015) New insights into the origin of the lumbrical muscles of the foot: tendinous slip of the flexor hallucis longus muscle. Surg Radiol Anat 37(10):1161–1167CrossRefGoogle Scholar
  8. 8.
    Hur MS, Kim JH, Woo JS, Choi BY, Kim HJ, Lee KS (2011) An anatomic study of the quadratus plantae in relation to tendinous slips of the flexor hallucis longus for gait analysis. Clin Anat 24(6):768–773CrossRefGoogle Scholar
  9. 9.
    Kenney WL, Wilmore J, Costill D (2015) Physiology of sport and exercise 6th edition. Human kineticsGoogle Scholar
  10. 10.
    Khonsary SA (2017) Guyton and Hall: textbook of medical physiology. Surg Neurol Int 8:275CrossRefGoogle Scholar
  11. 11.
    LaRue BG, Anctil EP (2006) Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons. Foot Ankle Int 27(7):528–532CrossRefGoogle Scholar
  12. 12.
    Lewis OJ (1962) The comparative morphology of M. flexor accessorius and the associated long flexor tendons. J Anat 96:321–333Google Scholar
  13. 13.
    Machida J, Inaba Y, Nakamura N (2017) Management of foot deformity in children. J Orthop Sci 22(2):175–183CrossRefGoogle Scholar
  14. 14.
    Mao H, Shi Z, Wapner KL et al (2015) Anatomical study for flexor hallucis longus tendon transfer in treatment of Achilles tendinopathy. Surg Radiol Anat 37:639–647CrossRefGoogle Scholar
  15. 15.
    Moore KL, Dalley AF, Agur AMR (2014) Clinically oriented anatomy, 7th edn. Lippincott Williams&Wilkins, BaltimoreGoogle Scholar
  16. 16.
    Mulier T, Rummens E, Dereymaeker G (2007) Risk of neurovascular injuries in flexor hallucis longus tendon transfers: an anatomic cadaver study. Foot Ankle Int 28(8):910–915CrossRefGoogle Scholar
  17. 17.
    O’Sullivan E, Carare-Nnadi R, Greenslade J, Bowyer G (2005) Clinical significance of variations in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry. Clin Anat 18(2):121–125CrossRefGoogle Scholar
  18. 18.
    Plaass C, Abuharbid G, Waizy H et al (2013) Anatomical variations of the flexor hallucis longus and flexor digitorum longus in the chiasma plantare. Foot Ankle Int 34(11):1580–1587CrossRefGoogle Scholar
  19. 19.
    Pretterklieber B (2017) The high variability of the chiasma plantare and the long flexor tendons: Anatomical aspects of tendon transfer in foot surgery. Ann Anat 211:21–32CrossRefGoogle Scholar
  20. 20.
    Salzmann M, Berger N, Rechl H, Döderlein L (2013) Spastische Fußdeformitäten im Kindesalter Spastic foot deformities in children. Der Orthopäde 42(6):434–441CrossRefGoogle Scholar
  21. 21.
    Standring S, Borley NR, Collins P, Crossman AR, Gatzoulis MA, Healy JC (2008) Gray’s anatomy: the anatomical basis of clinical practice, 40th edn. Elsevier, Churchill Livingstone, LondonGoogle Scholar
  22. 22.
    Tubbs RS, Shoja MM, Loukas M (2016) Bergman’s comprehensive encyclopedia of human anatomic variation. John Wiley & Sons, New JerseyGoogle Scholar
  23. 23.
    Uzmansel D, Kurtoglu Z, Kara A, Ozturk N (2010) Frequency, anatomical properties and innervation of axillary arch and its relation to the brachial plexus in human fetuses. Surg Radiol Anat 32(9):859–863CrossRefGoogle Scholar
  24. 24.
    Waugh CM, Blazevich AJ, Fath F, Korff T (2012) Age related changes in mechanical properties of the Achilles tendon. J Anat 220(2):144–155CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  • Özlem Elvan
    • 1
    Email author
  • Orhan Beger
    • 2
  • Meryem İlkay Karagül
    • 3
  • Deniz Uzmansel
    • 2
  • Necat Şakir Yılmaz
    • 3
  • Zeliha Kurtoğlu Olgunus
    • 2
  1. 1.School of HealthMersin UniversityMersinTurkey
  2. 2.Department of Anatomy, Faculty of MedicineMersin UniversityMersinTurkey
  3. 3.Department of Histology and Embryology, Faculty of MedicineMersin UniversityMersinTurkey

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