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The flexor hallucis longus is situated on the fibular side of the leg. It arises from the inferior two-thirds of the posterior surface of the body of the fibula, with the exception of 2.5 cm at its lowest part; from the lower part of the interosseous membrane; from an intermuscular septum between it and the peroneus muscles, laterally, and from the fascia covering the tibialis posterior, medially.
The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments.
If the quality of tissues is poor, such as from a neglected injury, a reinforcement mesh is an option. These meshes can be of collagen, Artelon or other degradable material. In the case of both poor tissue and significant loss of the Achilles tendon, the flexor hallucis longus tendon can be used.
Extensor hallucis longus: Middle part of anterior surface of fibula and interosseous membrane: Dorsal aspect of base of distal phalanx of great toe (hallux) Extends great toe and dorsiflexes ankle Extensor digitorum longus: Lateral condyle of tibia and superior three quarters of medial surface of fibula and interosseous membrane
Enumerated from the medial side, the four canals which it forms transmit the tendons of the tibialis posterior and flexor digitorum longus muscles; the posterior tibial artery and tibial nerve, which run through a broad space beneath the ligament; and lastly, in a canal formed partly by the talus, the tendon of the flexor hallucis longus.
Muscular branches - Supplies tibialis posterior, flexor digitorum longus, flexor hallucis longus, and deep part of soleus. [1] Cutaneus branches - The medial calcaneal nerve pierces the flexor retinaculum to supply the skin of the back and lower surface of the heel. [1] Articular branches - Supplies the ankle joint [1]
The flexor hallucis longus arises distally on the fibula and on the interosseus membrane from where its relatively thick muscle belly extends far distally. Its tendon extends beneath the flexor retinaculum to the sole of the foot and finally attaches on the base of the last phalanx of the hallux.
The flexor hallucis longus and flexor digitorum longus flex the interphalangeal joint of the big toe and lateral four toes, respectively. The tendons of both of these muscles cross as they reach their distal attachments. In other words, the flexor hallucis longus arises laterally, while the flexor digitorum longus arises medially.