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

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.     

Tonic and phasic discharge patterns in toe flexor gamma-motoneurons during locomotion in the decerebrate cat.

To investigate the specificity of fusimotor (gamma) drive during locomotion, gamma-efferents were recorded from the flexor digitorum longus (FDL) and flexor hallucis longus (FHL) nerves in a decerebrate cat preparation. These nerves innervate hindlimb muscles that differ in some aspects of their mechanical action. For both FHL and FDL two stereotyped patterns of gamma activity were distinguished. Tonic units fired throughout the step cycle and had less modulation, but higher minimum rates, than phasic units, which were mainly recruited with ankle extensor [soleus (SOL)] electromyogram (EMG) activity. Differences in the relative timing of these patterns were apparent. In FHL the activity of phasic and most tonic neurons peaked after EMG onset. With FDL, tonic units generally reached maximum rate before, while phasic units peaked after, the beginning of EMG activity. During locomotion FHL and FDL alpha activity were rhythmically recruited with SOL. However, consistent with previous reports, FHL and FDL differed in their patterns of alpha activity. FHL was stereotyped while FDL was variable. Both FHL and FDL had activity related to ankle extensor EMG, but only FDL exhibited a peak around the end of this phase. No corresponding gamma activity was observed in FDL. In conclusion, 1) FHL and FDL received tonic and phasic fusimotor drive; 2) there was no alpha/gamma linkage for the late FDL alpha burst; 3) phasic gamma-efferents in both muscles received similar inputs, linked to plantar flexor alpha activity; and 4) tonic gamma-efferents differed, to the extent that they were modulated at all. The FHL units peaked with the plantar flexor alphas. The FDL neurons generally peaked before alpha activity even began.     

Isolated flexor muscles of the little toe in the feet of an individual with atrophied or lacking 4 head of the M. extensor digitorum brevis and lacking the 4 tendon of the M. extensor digitorum longus

While dissecting the body of a 75-year-old male we observed variations in the Mm. flexor digitorum brevis and longus of both feet. In the left foot, the 4th tendon of the M. flexor digitorum brevis was atrophied and the respective tendon of the M. flexor digitorum longus to the little toe was absent. In the right foot, the 4th tendons of both the Mm. flexor digitorum brevis and longus to the little toe were absent. The lacking deep flexor tendon to the little toe in the left foot was replaced by an isolated flexor muscle originating from the medial and lateral processes of the calcaneal tuberosity, which additionally had connections to the tendinous plate of the M. flexor digitorum longus and the M. quadratus plantae. The absent superficial and deep flexor tendons to the little toe in the right foot were replaced by an isolated flexor muscle arising from the M. quadratus plantae distal from the medial process of the calcaneal tuberosity. The tendon of both isolated flexor muscles inserted in the distal phalanx of the little toe. The left isolated flexor muscle for the little toe had connections to the M. flexor digitorum longus and the M. quadratus plantae. From these results it seems likely that the M. quadratus plantae could be regarded as additional flexor head (caput breve or plantare) of the M. flexor digitorum longus as is described in classic textbooks. In the individual's lifetime the described variation perhaps led to the possibility of an isolated flexion of the little toe.     

Peripheral and central control of flexor digitorum longus and flexor hallucis longus motoneurons: The synaptic basis of functional diversity

Summary The two long toe flexor muscles in the cat, flexor digitorum longus (FDL) and flexor hallucis longus (FHL), have essentially identical mechanical actions, yet are used very differently during locomotion (O'Donovan et al. 1982). We attempted to identify the origin of the synaptic drive responsible for this functional differentiation.The organization of peripheral and central synaptic drive to FDL and FHL motoneurons was examined using two basic paradigms. (1) In animals anesthetized with chloralose or after ischemic destruction of the brain, peripheral reflex circuits were studied by recording intracellular responses from -motoneurons produced by electrical stimulation of muscular and cutaneous nerves. (2) Fictive locomotion, the centrally generated rhythmic synaptic drive produced in paralyzed, decerebrate animals by stimulation of the mesencephalic locomotor region or intravenous injection of L-DOPA and Nialamide, was monitored by recording electro-neurograms from the central end of cut motor nerves.Despite their functional dissimilarity, FDL and FHL motoneurons received monosynaptic EPSPs from both FDL and FHL la afferents. Ipsilateral cutaneous afferents in the sural nerve and from the central plantar pad produced multiphasic PSPs which were not different in FDL and FHL cells. However afferents from the saphenous and superficial peroneal nerves did exert differential effects: the first component of the multiphasic PSP in most FDL cells was an EPSP, which was not present in most FHL cells. The central latency of this early EPSP in FDL motoneurons (0.8–1.5 ms) strongly suggests a disynaptic linkage. Cutaneous afferents from the ipsilateral forelimb produced IPSPs in most FHL cells but in only one of 18 FDL cells. Since some peripheral reflex circuits exerted differential effects on FDL and FHL cells, but others did not, the intracellular data did not demonstrate that the functional differences between FDL and FHL could be explained by differences in reflex organization.During fictive locomotion elicited by electrical or pharmacological stimulation, FHL motoneurons were coactive with ankle extensors during the extension phase of the fictive step cycle. In contrast, FDL motoneurons were most consistently activated in a brief burst at the onset of the flexion phase, showing much weaker and more variable coactivity with ankle extensors. These patterns were essentially identical to those reported for FDL and FHL motor pools during treadmill locomotion by O'Donovan et al. (1982).We conclude that the central pattern generator (CPG) for locomotion produces distinct and highly differentiated sets of instructions for FDL and FHL motoneurons. Peripheral and descending systems are important in initiating and biasing the activity of the CPG, but are not responsible for the intrinsic structure of the locomotor command signals.     

Recurrent collaterals of motoneurons projecting to distal muscles in the cat hindlimb.

1. Recurrent collaterals of motoneurons innervating muscles that have a role in control of the hindlimb digits were studied with neuroanatomic tracing methods to determine whether these motoneurons have simple recurrent collateral arbors in comparison with those of hip, knee, and ankle muscles. 2. Motoneurons innervating the hindlimb muscles plantaris (Pln), flexor hallucis longus (FHL), or flexor digitorum longus (FDL) were injected with 10% horseradish peroxidase. Recurrent collaterals were reconstructed from serial transverse sections. 3. No recurrent collaterals were observed in a sample of 10 FDL motoneurons. 4. FHL motoneurons had simple recurrent collateral arbors as assessed by number of first-order collaterals, number of collateral swellings, number of end branches, and the highest-order branch of individual collateral trees. Recurrent collateral arbors of Pln motoneurons were more complex than those of FHL motoneurons. Pln and FHL recurrent collateral arbors were less complex than those described for gastrocnemius-soleus, anterior tibial, and posterior biceps motoneurons. 5. These anatomic findings correspond well with electrophysiological results indicating that the recurrent inhibition produced by FHL motoneurons is weak and that FDL motoneurons do not produce recurrent inhibition. In addition, Pln motoneurons are reported to produce stronger recurrent inhibition than FHL motoneurons in many motor pools. 6. Consideration of these results with respect to the mechanical actions and patterns of motor activity observed in FDL, FHL, and Pln suggests that the complexity of recurrent collaterals of a motoneuron pool and the extent of its contribution to recurrent inhibition diminish with its involvement in the individualized control of the digits.     

Toe flexor muscle spindle discharge and stretch modulation during locomotor activity in the decerebrate cat

In order to investigate the nature (i.e. static or dynamic) of fusimotor drive to the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles during locomotion we recorded Ia and group II muscle spindle afferent responses to sinusoidal stretch (0.25 and 1 mm amplitude, respectively, 4–5 Hz) in a decerebrate cat preparation. FHL Ia and group II afferents generally had increased discharge rates and decreased modulation to stretch throughout the step cycle, compared to rest, suggesting raised static γ drive at all locomotor phases. Although the modulation of Ia afferents was reduced during locomotion, most (13 of 18) showed a clear increasing trend during homonymous muscle activity (extension). This was consistent with phasic dynamic γ drive to FHL spindles linked with α drive. In agreement with previous reports, FHL gave a single burst of EMG activity during the step cycle while FDL α drive had two components. One was related to extension while the other comprised a brief burst around the end of this phase. Typically FDL Ia and group II afferents also had elevated firing rates and reduced modulation at all locomotor phases, again implicating static γ drive. Half the afferents (seven Ia, three group II) showed increased discharge during extension, suggesting phasic static γ drive. There was no γ drive associated with the late FDL α burst. In conclusion, the γ drives to FHL and FDL differed during locomotion. FHL, which has the α drive of a classic extensor, received γ drive that closely resembled other extensors. The γ drive of FDL, which exhibits both extensor and flexor α synergies, did not match either muscle type. These observations are compatible with the view that fusimotor drive varies in different muscles during locomotion according to the prevailing sensorimotor requirements.     

足部相关肌肉、肌腱组织材料弹性模量的测定

背景：目前,几乎所有足部三维有限元模型的材料参数均来自国外研究,尚未见有关国人组织材料参数的测量与报道。 目的：对国人足部的相关肌肉、肌腱材料做测量,获得初步的参数数据。 方法：解剖成年女性左小腿足新鲜标本拇长屈肌及其肌腱、拇短屈肌内外侧头、拇长伸肌及其肌腱、拇收肌横头及斜头、拇展肌,分别测量和计算各试样的截面积和位于夹具之间的长度并记录数值,将标本加载载荷,1个测样反复测量4次,采集强度极限、最大载荷等数据,以及载荷-位移曲线。根据胡克定律,计算各标本的弹性模量。 结果与结论：共得到了包括拇长伸肌、拇长屈肌、拇收肌、拇展肌横头和斜头、拇短屈肌内外侧头、拇长屈肌腱、拇长伸肌腱9个样本的相关测量数据,主要包括长度、宽度、厚度、横截面积、最大载荷、强度极限和弹性模量。中国组织工程研究杂志出版内容重点：生物材料;骨生物材料; 口腔生物材料; 纳米材料; 缓释材料; 材料相容性;组织工程全文链接：     

趾长屈肌的亚部化研究及其临床意义

目的　探讨趾长屈肌的亚部划分，为临床外科“半肌”移位手术提供解剖学基础。 方法　大体解剖法、肌构筑法、改良Sihler’s 染色法。 结果　①可依劈开趾长屈肌肌内腱板，把该肌分为胫侧和腓侧两个亚部；②胫侧亚部各构筑学值大于腓侧亚部；③两亚部存在单独神经支配。 结论　①趾长屈肌可分为胫侧亚部和腓侧亚部，两亚部有独立的神经支配；②趾长屈肌的两个亚部均为半羽肌，胫侧亚部产生的肌力大于腓侧亚部。     

Anatomical dissection of the deep posterior compartment and its correlation with clinical reports of chronic compartment syndrome involving the deep posterior compartment

Patients with clinical presentation of deep posterior chronic compartment syndrome (CCS) frequently have symptoms limited to either proximal or distal components of the deep posterior compartment. In this study the posterior aspect of 15 cadaver legs was dissected to document anatomical separations and delineate boundaries, if any, of the deep posterior compartment and to correlate the findings to these patients. Origins of flexor hallucis longus (FHL), flexor digitorum longus (FDL), and tibialis posterior (TP), as well as whether TP existed in its own osseofascial compartment, were noted. Ten specimens had an identifiable distinct layer of tissue separating the deep posterior compartment into two potentially clinically relevant components. Much of this layer was derived from origins of FDL and its anatomical position in relation to the TP muscle. In seven of these cases, FDL had a significant fibular origin in addition to the well-established tibial origin. This essentially compartmentalized the distal third of the tibialis posterior as it descends anterior and medial to FDL in the lower one-third of the leg in five specimens. No cadaver possessed a significant fascial septum encasing TP and separating it from other deep posterior muscles. This study confirms the existence of a proximal and distal sub-compartment of the deep posterior compartment as a variant and supports the most frequent clinical presentation of deep posterior CCS as involving either the distal or proximal deep compartment, rather than the entire deep posterior compartment. The anatomic arrangement of muscles in the deep posterior compartment creates sub-compartments, which may explain the successful outcomes following a deep compartment release limited to symptomatic portion(s) of the deep compartment. Clin. Anat. 10:104–111, 1997 © 1997 Wiley-Liss, Inc.     

Epifascial accessory palmaris longus muscle

In hand reconstructive surgery the palmaris longus muscle is one of the most utilized donor site for tendon reconstruction procedures. However, its anatomic position is variable and anatomic variations may be responsible for median nerve compression. We report the case of a 40-year-old, right-handed woman, who presented with numbness and paresthesias in the palm and in the flexor aspect of the first, second, and third fingers of her right hand for the preceding 5 months, coinciding with increase of office work (typing). The clinical examination and radiological investigations (ultrasound and magnetic resonance) revealed a subcutaneous mass (15 mm x 2.3 mm x 6 cm), with a lenticular shape and definite edges at the level of the volar aspect of the distal third of the forearm. The fine-needle aspiration biopsy revealed the presence of striated muscle fibers. During surgery, a muscle belly was found in the epifascial plane. This muscle originated from subcutaneous septa in the middle forearm and inserted on to the superficial palmar aponeurosis with fine short tendon fibers. Exposure of the antebrachial fascia did not reveal any area of weakness or muscle herniation. The palmaris longus tendon, flexor digitorum superficialis tendons, and flexor carpi radialis tendon showed usual topography under the antebrachial fascia. The accessory muscle was excised and histology revealed unremarkable striated muscle fibers, limited by a thin connective sheath. The presence of an accessory palmaris longus (APL) located in the epifascial plane could be ascribed to an unusual migration of myoblasts during the morphogenesis. Although extremely rare, APL is worth bearing in mind as a possible cause of median nerve compression and etiology of a volar mass in the distal forearm.     

The distal hindlimb musculature of the cat

Summary Chronic recordings were made of electromyographic (EMG) activity, tension, and length of distal hindlimb muscles in six cats performing a variety of normal motor tasks. Muscles studied thoroughly or in part were medial gastrocnemius, lateral gastrocnemius, plantaris, soleus, flexor digitorum brevis, flexor digitorum longus, flexor hallucis longus, tibialis posterior, tibialis anterior, extensor digitorum longus, peroneus longus, and peroneus brevis. Postural and locomotor activities were examined, as well as jumping, landing, scratching, and paw shaking. In general, muscles could be assigned to traditional groupings (e.g. extensor, flexor) related to the demands of the motor task. Patterns of muscle activity were most often consistent with current understanding of muscle mechanics and neural coordination. However, purely functional distinctions between flexor digitorum longus and flexor hallucis longus (anatomical synergists) were made on the basis of activity patterns. Likewise, the activity of plantaris and flexor digitorum brevis, which are attached in series, was differentiated in certain tasks. The rhythmical oscillatory patterns of scratching and paw shaking were found to differ temporally in a manner consistent with the limb mechanics. In several cases, mechanical explanations of specific muscle activity required length and force records, as well as EMG patterns. Future efforts to study motor patterns should incorporate information about the relationships between muscle activation, tension, length and velocity.Abbreviations EDL extensor digitorum longus - FDB flexor digitorum brevis - FDL flexor digitorum longus - FHL flexor hallucis longus - LG lateral gastrocnemius - MG medial gastrocnemius - PB peroneus brevis - PL peroneus longus - PLT plantaris - SOL soleus - TA tibialis anterior - TP tibialis posterior Limbs A ankle - K knee - LF left forelimb - LH left hindlimb - RF right forelimb - RH right hindlimb Step Cycle Phases E₁ first extension, late swing phase prior to footfall - E₂ second extension, early stance phase - E₃ third extension, late stance phase - F flexion, early swing phase     

The functional anatomy of Kager's fat pad in relation to retrocalcaneal problems and other hindfoot disorders

Kager's fat pad is a mass of adipose tissue occupying Kager's triangle. By means of a combined magnetic resonance imaging, ultrasound, gross anatomical and histological study, we show that it has three regions that are closely related to the sides of the triangle. Thus, it has parts related to the Achilles and flexor hallucis longus (FHL) tendons and a wedge of fat adjacent to the calcaneus. The calcaneal wedge moves into the bursa during plantarflexion, as a consequence of both an upward displacement of the calcaneus relative to the wedge and a downward displacement of the wedge relative to the calcaneus. During dorsiflexion, the bursal wedge is retracted. The movements are promoted by the tapering shape of the bursal wedge and by its deep synovial infolds. Fibrous connections linking the fat to the Achilles tendon anchor and stabilize it proximally and thus contribute to the motility of its tip. We conclude that the three regions of Kager's fat pad have specialized functions: an FHL part which contributes to moving the bursal wedge during plantarflexion, an Achilles part which protects blood vessels entering this tendon, and a bursal wedge which we suggest minimizes pressure changes in the bursa. All three regions contribute to reducing the risk of tendon kinking and each may be implicated in heel pain syndromes.     

The frequency of absence of palmaris longus in a South African population of mixed race

The palmaris longus (PL) is a weak flexor of the wrist that may be harvested as a tendon graft and used in surgical procedures for reconstructive purposes. The PL is congenitally absent in 15% of the worldwide population. However, the frequency of absence varies considerably among different population groups, being as high as 63.9% in the Turkish population and as low as 3% in the black population in the Republic of Congo. In this study, South African persons of mixed race (n = 201) were assessed by two anatomists for the presence of the PL tendon using three clinical tests, namely the Traditional Test, Mishra's Test II, and the Gangata Test. The most reliable of the three tests used was determined using Kendall's coefficient of concordance. Of the total number of subjects used, 11.5% had absence (either bilaterally or unilaterally) of the PL tendon. There was a 5.5% bilateral absence of the PL. The study revealed that the PL tendon may present in six different patterns according to the clinical assessment tests applied, the presence or absence of the PL alongside the flexor capi radialis, and the degree of prominence of PL, if present. Using the Kendall's coefficient of concordance, the Mishra's Test II, and the Gangata Test, both involving abduction of the thumb, were found to be most effective in revealing the PL. The frequency of absence of the PL in South Africans of mixed race has been determined. Clin. Anat. 23:437–442, 2010. © 2010 Wiley‐Liss, Inc.     

An unusual flexor hallucis longus muscle

During the dissection of the posterior compartment of the left leg, an unusual flexor hallucis longus muscle of a fifty two years-old male cadaver was observed. On the medial side of the flexor hallucis longus, on its lower distal half, a prominent aponeurotic structure was observed. A small unusual muscle mass was attached to this aponeurotic structure. The muscular fibres of the unusual mass were arranged in form of bipennate muscle. It originated via a broad tendon from the muscular fibres of the tibialis posterior and the deep transverse fascia covering the same muscle. It inserted on the aponeurosis of the lower medial half of the flexor hallucis longus muscle. Having in mind the very different pathology in the region of the ankle and the foot, the significance of such a muscle mass could be of practical importance.     

Clinical significance of variations in the interconnections between flexor digitorum longus and flexor hallucis longus in the region of the knot of Henry

Tendon transfer of the flexor digitorum longus tendon (FDLT) or the flexor hallucis longus tendon (FHLT) into the tibialis posterior tendon is carried out in patients with tibialis posterior dysfunction. FDLT and FHLT are connected in the region of the knot of Henry. The present study has investigated the anatomical variations of this tendinous interconnection. The results could be used to determine which of the two tendons should be transected proximal to the region of the knot of Henry in the surgical treatment of tibialis posterior dysfunction. In over two-thirds of cadaver specimens investigated, tension applied solely to FHLT resulted in flexion of all digits and the hallux. On the basis of these results, we propose that identification of the tendon to be transected should be decided at the time of surgery depending on the anatomical pattern. Based on the evidence provided by 16 cadaveric dissections, transection of FDLT proximal to the region of the knot of Henry for the repair of tibialis posterior dysfunction would result in retention of function of the hallux and lesser digits in the majority of cases.     

Double tendons at the distal attachment of the extensor hallucis longus muscle

The distal attachments of the extensor hallucis longus (EHL) tendons in 47 amputated legs and in eight cadavers were examined. The EHL had two tendons in 34 of the amputated legs and bilaterally in five cadavers. The lateral tendon was inserted to the middle of the dorsal aspect of the base of the distal phalanx of the hallux and the medial tendon to the medial side of the insertion of the lateral tendon. The length and thickness of these two tendons were measured and compared in order to obtain data for using these tendons in tendon repair and hallux varus corrections by autogenous tendon transfer surgery. Additionally, on the right foot of one of the cadavers, it was observed that the extensor hallucis brevis tendon united with the lateral tendon of the EHL. We recommend that foot-ankle surgeons be aware of the various accessory EHL tendons and their potential use in problematic cases.     

The clinical surface anatomy anomalies of the palmaris longus muscle in the Black African population of Zimbabwe and a proposed new testing technique

The presence of the palmaris longus muscle (PLM) is highly variable. Rates of absence vary from 0.6% in the Korean population to as high as 63.9% in the Turkish population. The tendon of PLM may be absent on one or both forearms, may have duplicated tendons on one forearm or may be laterally shifted to the extent that the tendon of the PLM lies superficial to that of flexor carpi radialis muscle. Among Black American populations, in which there is usually mixed ancestry, rates of absence are 3.5%. Only two studies have been performed on Black African populations: in Republic of Congo and Uganda, and each showed widely differing rates of absence of 3.0% and 14.6%, respectively. In this study, a total of 890 Black Zimbabwean subjects in Harare aged between 8 and 13 years, were examined for clinical surface anatomy anomalies of the tendon of PLM. The results showed that the tendon of the PLM was absent unilaterally in 0.9% of the population, and bilaterally absent in 0.6% with an overall rate of absence of 1.5%. Other variations noted were a laterally shifted PLM in 1.1% of subjects and duplicated tendons on one forearm, which was the least prevalent anomaly, in 0.2% of subjects. The author proposes a new technique to test the tendon of PLM, which combines resisted thumb abduction and resisted wrist flexion. The proposed technique capitalizes on the role of the PLM as an important abductor of the thumb. Clin. Anat. 22:230–235, 2009. © 2009 Wiley‐Liss, Inc.     

Why does man have a quadratus plantae? A review of its comparative anatomy

Quadratus plantae is a muscle in the sole of the foot, typically originating from the calcaneus and inserting into the posterolateral surface of the tendons of flexor digitorum longus. It is implicated in heel pain, claw toe deformity and diabetic polyneuropathy. Phylogenetic considerations suggest that quadratus plantae is getting bulkier, implying its significance in human locomotion. Is it simply an accessory flexor that brings the line of pull of flexor digitorum longus in line with the long axis of the foot, as its name would suggest? We cite evidence from electromyographic studies that suggest it actually acts as a primary toe flexor in voluntary movements, being preferentially recruited over flexor digitorum longus. From comparative anatomical considerations it also seems likely that quadratus plantae is an intrinsic evertor of the foot. Eversion is an important evolutionary asset, especially in erect bipedalism. Human electromyographic experiments have yet to confirm this. However, they do suggest that quadratus plantae functions to resist extension of the toes during the stance phase of locomotion, which serves to increase the stability of the foot. Future electromyographic experiments may provide more information on the role of quadratus plantae in human locomotor evolution and in foot eversion in particular.