Type of Article:  Original Research

Volume 7; Issue 2.2 (May 2019)

Page No.: 6531-6535

DOI: https://dx.doi.org/10.16965/ijar.2019.161


V. Manikanta Reddy *1, V. Vallishri 2, C. K. Lakshmi Devi 3.

*1 Department of Anatomy, ACSR Government Medical College, Nellore, AP, India.

2 Department of Pediatrics, Pondicherry Institute of Medical Sciences, Pondicherry, India.

3 Department of Anatomy, ACSR Government Medical College, Nellore, AP, India.

Corresponding Author: Dr. V. Manikanta Reddy, Assistant Professor, Department of Anatomy, ACSR Government Medical College, Nellore, Andhra Pradesh, India. +91 9490907429; E-Mail: manikantareddy.v@gmail.com


Introduction: Flexor Hallucis Longus (FHL) and Flexor Digitorum Longus (FDL) are long flexors of the toes, often with the interconnecting tendinous slips at various points. These interconnecting slips hold great significance in reconstruction surgeries of ankle and foot such as chronic Achilles tendon rupture, posterior tibial tendon dysfunction (PTTD) and peroneal tendon rupture. In view of the above this study was aimed to find out various types of connections between tendons of FHL & FDL.

Materials and methods: This cross sectional study was carried out in the Department of Anatomy ACSR Government Medical College, Nellore, conducted in a total of 34 lower limbs. Flexor digitorum brevis and abductor hallucis muscles were reflected distally after the removal of the skin, superficial fascia and plantar aponeurosis to expose FHL and FDL tendons which were examined for the interconnections. Specimens with interconnections were photographed and documented.

Result: Out of 34 samples, 17 were right sided and 17 were of left sided. Mean foot length was 22.4 ± 1.9 cm. Three types of connections i.e. type 1, 4 & 5 were documented at 17 (50%), 16 (47.1%) and 1 (2.9%) type 5 respectively. Type 1 tendinous connections were further classified into 3 sub types i.e. type 1A were 10 (58.8%), type 1B were 5(29.4%) and type C were of 2(11.8%).

Conclusion: This study finds maximum distribution of type1 interconnections followed by type 4 and sub type 1A among type 1. This study also reports for the first time a common origin of 1st lumbrical from distal part of tendinous slip as well as from 1st digital slip of FDL. These interconnections provide stable base and enhanced propulsion by toes and also act as natural tenodesis.

Key words: Flexor Hallucis Longus, Flexor Digitorum Longus, tendinous interconnecting slips.


  1. Parul Kaushal, AritraBanerjee, PushpaDhar. Knot of Henry: Role in Tendon Transfer. Journal of Clinical and Diagnostic Research. 2017;11(12): 01-02.
  2. Julien Wegrzyn, Jean-François Luciani, Rémi Philippot, Elisabeth Brunet-Guedj, Bernard Moyen & Jean-Luc Besse. Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer. International Orthopaedics (SICOT) 2010; 34:1187–1192.
  3. Amlang M, Rosenow MC, Friedrich A, Zwipp H, Rammelt S. Direct plantar approach to Henry’s Knot for flexor hallucis ongus transfer. Foot Ankle Int. 2012;33(1):7-13.
  4. DiPaola M, Raikin SM. Tendon transfers and realignment osteotomies for treatment of stage II posterior tibial tendon dysfunction. Foot Ankle Clin. 2007;12(2):273-285.
  5. Christian Plaass, Ghassan Abuharbid, Hazibullah Waizy, Matthias Ochs, Christina Stukenborg-Colsman, and Andreas Schmiedl. Anatomical Variations of the Flexor Hallucis Longus and Flexor Digitorum Longus in the Chiasma Plantare. Foot & Ankle International 2016;34(11):1580– 1587.
  6. Mutsuaki Edama, Masayoshi Kubo, Hideaki Onishi, Tomoya Takabayashi, Erika Yokoyama, Takuma Inai, Hiroshi Watanabe, Satoshi Nashimoto, Ikuo Kageyama. Anatomical study of toe flexion by flexor hallucis longus. Annals of Anatomy 2016;204:80–85.
  7. LaRue BG, Anctil EP. Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons. Foot Ankle Int. 2006;27:528-32.
  8. Orhan Beger, Ozlem Elvan, Mert Keskinbora, Burçin Ün, Deniz Uzmansel, Zeliha Kurtoglu. Anatomy of Master Knot of Henry: A morphometric study on cadavers. Acta Orthopaedica et Traumatologica Turcica 2018;52:134e142.
  9. Yamamoto M, Shiraishi Y,  Kitamura K,  Jin ZW,  Murakami G,  Rodríguez-Vázquez JF, Abe SI. Early embryonic development of long tendons in the human foot. Okajimas Folia Anat Jpn.2016;93(2):59-65.
  10. Mao H, Shi Z, Wapner KL, Dong W, Yin W, Xu D. Anatomical study for flexor hallucis longus tendon transfer in treatment of Achilles tendinopathy. Surg Radiol Anat. 2015;37(6):639-647.
  11. Mao H, Dong W, Shi Z, Yin W, Xu D, Wapner KL. Anatomical Study of the Neurovascular in Flexor Hallucis Longus Tendon Transfers. Scientific reports. 2017 Oct 27;7(1):14202. 

Cite this article: V. Manikanta Reddy, V. Vallishri, C. K. Lakshmi Devi. STUDY ON TENDINOUS CONNECTIONS BETWEEN FLEXOR HALLUCIS LONGUS AND FLEXOR DIGITORUM LONGUS. Int J Anat Res 2019;7(2.2):6531-6535. DOI: 10.16965/ijar.2019.161