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The adductor hallucis revisited.

S Owens¹, D B Thordarson

¹Department of Orthopaedic Surgery, Keck School of Medicine, University of Southern California, Los Angeles 90089-9312, USA.

Foot & Ankle International

|April 20, 2001

Summary

Understanding great toe anatomy is crucial for hallux valgus surgery. This study reveals the adductor hallucis tendon often conjoins with the flexor hallucis brevis, cautioning against isolated releases.

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Area of Science:

Anatomy
Orthopedic Surgery
Biomechanics

Background:

The adductor hallucis muscle plays a significant role in great toe stability and hallux valgus deformity.
Surgical release of the adductor hallucis tendon is a common procedure, but its precise insertion anatomy can vary.
Variability in tendon insertion may impact surgical outcomes and the effectiveness of soft tissue realignment.

Purpose of the Study:

To investigate the anatomical variations in the insertion of the adductor hallucis tendon into the lateral sesamoid and proximal phalanx of the great toe.
To assess the extent of adductor hallucis tendon release achievable through a dorsal first-web space incision.

Main Methods:

Analysis of 42 fresh-frozen human cadaveric specimens.
Recording of hallux valgus angles.
Dissection through a dorsal first-web incision to isolate the adductor hallucis tendon and evaluate its insertion, including potential conjoined slips with the flexor hallucis brevis.

Main Results:

In most specimens (33/42), the entire adductor hallucis tendon was isolated via the dorsal incision.
No separate adductor hallucis tendon insertions into the proximal phalanx were identified; all specimens showed a conjoined insertion with the flexor hallucis brevis from the lateral sesamoid.
Release of the adductor hallucis tendon from the lateral sesamoid via the dorsal incision provided adequate release in most cases.

Conclusions:

The adductor hallucis tendon typically inserts conjoined with the flexor hallucis brevis tendon into the proximal phalanx.
Surgeons should exercise caution when releasing what appears to be an isolated adductor tendon insertion, as it may be part of a conjoined structure.
A dorsal first-web incision is effective for releasing the adductor hallucis tendon from its sesamoid insertion.

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