Does the tendon retract in flexor hallucis longus muscle laceration? A cadaveric study

Flexor hallucis longus (FHL) tendon injuries are common, particularly in open injuries caused by sharp objects. However, data regarding FHL tendon retraction following hallux-level FHL tendon lacerations remain limited. This study investigated the retraction and shortening of the FHL tendon using cadaveric models.

Six fresh-frozen below-knee amputated cadaveric feet (mean age: 65 years, range: 62-88) were utilized. FHL tendons were dissected, and lacerations were simulated at the hallux level. Tendons were subjected to various tensile forces (20-120 N) using a mechanical device. Force was measured in Newtons via a loadcell, and retraction distance was recorded in millimeters using an encoder. Data were summarized as mean ± standard deviation (SD), median, and quartiles.

The FHL tendon retracted gradually as applied force increased. An average retraction of 7 mm was measured at 20 N, reaching 21 mm at 60 N. Beyond 60 N (> 21 mm retraction), the other four toes also flexed. This occurs due to the anatomical connection between the FHL and flexor digitorum longus (FDL) tendons.

Only slight retraction was observed in hallux-level FHL tendon lacerations. At most, the findings suggest that distal FHL lacerations may exhibit limited proximal retraction under the tested conditions, which may have implications for surgical planning. Understanding FHL biomechanics is essential for developing effective repair strategies. Further investigation into the clinical implications of these findings is warranted.