{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T08:34:15Z","timestamp":1792139655152,"version":"4.4.0"},"reference-count":29,"publisher":"MDPI AG","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:sec id=\"st1\">\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>We sought to show the biomechanical and morphometric properties of flexor hallucis longus (FHL) and flexor digitorum longus (FDL) tendon grafts harvested by specific surgical approaches and to assess the contribution of FHL slips to the long flexor tendons of the toes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st2\">\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Thirteen fresh-frozen amputated feet (average age, 79 years) were dissected. The connections between the FHL and FDL tendons and the contribution of FHL slips to the long flexor tendons were classified. The biomechanical properties of the tendons and slips were measured using a tensile device.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st3\">\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The connections between the FHL and FDL tendons were reviewed in two groups. Group 1 had FHL slips (11 cases) and group 2 had cross-slips (two cases). The FHL slips joined the second and third toe long flexor tendon structures. Tendon length decreased significantly from the second to the fifth toe (\n                      <jats:italic>P<\/jats:italic>\n                      &lt; .001). Apart from the second toe tendon being thicker than that of the fourth toe (\n                      <jats:italic>P<\/jats:italic>\n                      = .02) and Young's modulus being relatively smaller in the third versus the fourth toe tendon (\n                      <jats:italic>P<\/jats:italic>\n                      = .01), biomechanical and morphometric properties of second to fourth tendons were similar. Mechanical properties of those tendons were significantly different from fifth toe tendons and FHL slips. Morphometric and biomechanical properties of FHL slips were similar to those of the fifth toe tendon.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"st4\">\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Herein, FHL slips were shown to have biomechanical properties that might contribute to flexor functions of the toes. During the harvesting of tendon grafts from the FHL by minimally invasive incision techniques from the distal plane of the master knot of Henry, cutting slips between FHL and FDL tendons could be considered a cause of postoperative function loss in toes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7547\/17-063","type":"journal-article","created":{"date-parts":[[2017,11,13]],"date-time":"2017-11-13T12:05:25Z","timestamp":1510574725000},"page":"282-290","source":"Crossref","is-referenced-by-count":7,"title":["Biomechanical and Morphometric Properties of the Long Flexor Tendons of the Toes: A Cadaver Study"],"prefix":"10.3390","volume":"109","author":[{"given":"Orhan","family":"Beger","sequence":"first","affiliation":[{"name":"Department of Anatomy, Mersin University, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamze","family":"Tumentem\u00fcr","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Ac\u0131badem University Faculty of Medicine, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Co\u015far","family":"Uzun","sequence":"additional","affiliation":[{"name":"Department of Biophysics, Mersin University Faculty of Medicine, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elif Nedret","family":"Keskin\u00f6z","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Ac\u0131badem University Faculty of Medicine, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00d6zlem","family":"Elvan","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Mersin University, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Deniz","family":"Uzmansel","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Mersin University, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mert","family":"Keskinbora","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Istanbul Medipol University Hospital, Istanbul, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurten","family":"Erdal","sequence":"additional","affiliation":[{"name":"Department of Biophysics, Mersin University Faculty of Medicine, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bahar","family":"Ta\u015fdelen","sequence":"additional","affiliation":[{"name":"Department of Biostatistics, Mersin University, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeliha","family":"Kurto\u011flu","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Mersin University, Mersin, Turkey."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","reference":[{"key":"i8750-7315-109-4-282-b01","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"7","DOI":"10.3113\/FAI.2012.0007","article-title":"Direct plantar approach to Henry's knot for flexor hallucis longus transfer","volume":"33","author":"Amlang \n              M,","year":"2012","unstructured":"Amlang \n              M, \n            \n            \n              Rosenow \n              MC, \n            \n            \n              Friedrich \n              A, \n            \n            et al: \n          Direct plantar approach to Henry's knot for flexor hallucis longus transfer. Foot Ankle Int33: 7, 2012.10.3113\/FAI.2012.000722381230"},{"key":"i8750-7315-109-4-282-b02","series-title":"Surg Radiol Anat","doi-asserted-by":"publisher","first-page":"639","DOI":"10.1007\/s00276-014-1399-y","article-title":"Anatomical study for flexor hallucis longus tendon transfer in treatment of Achilles tendinopathy","volume":"37","author":"Mao \n              H,","year":"2015","unstructured":"Mao \n              H, \n            \n            \n              Shi \n              Z, \n            \n            \n              Wapner \n              KL, \n            \n            et al: \n          Anatomical study for flexor hallucis longus tendon transfer in treatment of Achilles tendinopathy. Surg Radiol Anat37: 639, 2015.10.1007\/s00276-014-1399-y25542244"},{"key":"i8750-7315-109-4-282-b03","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"457","DOI":"10.3113\/FAI.2010.0457","article-title":"Technique tip: a new technique for harvest of the flexor hallucis longus tendon","volume":"31","author":"Murphy \n              RL,","year":"2010","unstructured":"Murphy \n              RL, \n            \n            \n              Womack \n              JW, \n            \n            \n              Anderson \n              T: \n            \n          \n          Technique tip: a new technique for harvest of the flexor hallucis longus tendon. Foot Ankle Int31: 457, 2010.10.3113\/FAI.2010.045720460076"},{"key":"i8750-7315-109-4-282-b04","series-title":"Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/j.fas.2009.06.003","article-title":"Flexor digitorum longus tendon exposure for flat foot reconstruction: a comparison of two methods in a cadaveric model","volume":"16","author":"Oddy \n              MJ,","year":"2010","unstructured":"Oddy \n              MJ, \n            \n            \n              Flowers \n              MJ, \n            \n            \n              Davies \n              MB: \n            \n          \n          Flexor digitorum longus tendon exposure for flat foot reconstruction: a comparison of two methods in a cadaveric model. 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Foot Ankle Int29: 42, 2008.10.3113\/FAI.2008.004218275735"},{"key":"i8750-7315-109-4-282-b07","series-title":"Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1016\/j.fas.2007.08.003","article-title":"Surgical anatomy for a new minimally invasive approach to the flexor digitorum longus tendon: a cadaver study","volume":"14","author":"Panchbhavi \n              VK,","year":"2008","unstructured":"Panchbhavi \n              VK, \n            \n            \n              Yang \n              J, \n            \n            \n              Vallurupalli \n              S: \n            \n          \n          Surgical anatomy for a new minimally invasive approach to the flexor digitorum longus tendon: a cadaver study. Foot Ankle Surg14: 16, 2008.1908360610.1016\/j.fas.2007.08.003"},{"key":"i8750-7315-109-4-282-b08","series-title":"Foot Ankle Surg","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.fas.2012.10.002","article-title":"Flexor digitorum longus tendon harvest length utilising a limited operative exposure: a cadaveric study","volume":"19","author":"Park \n              DH,","year":"2013","unstructured":"Park \n              DH, \n            \n            \n              Gill \n              IR, \n            \n            \n              Solan \n              MC: \n            \n          \n          Flexor digitorum longus tendon harvest length utilising a limited operative exposure: a cadaveric study. Foot Ankle Surg19: 53, 2013.2333727810.1016\/j.fas.2012.10.002"},{"key":"i8750-7315-109-4-282-b09","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"1580","DOI":"10.1177\/1071100713494780","article-title":"Anatomical variations of the flexor hallucis longus and flexor digitorum longus in the chiasma plantare","volume":"34","author":"Plaass \n              C,","year":"2013","unstructured":"Plaass \n              C, \n            \n            \n              Abuharbid \n              G, \n            \n            \n              Waizy \n              H, \n            \n            et al: \n          Anatomical variations of the flexor hallucis longus and flexor digitorum longus in the chiasma plantare. Foot Ankle Int34: 1580, 2013.2378823310.1177\/1071100713494780"},{"key":"i8750-7315-109-4-282-b10","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"627","DOI":"10.3113\/FAI.2009.0627","article-title":"Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer","volume":"30","author":"Richardson \n              DR,","year":"2009","unstructured":"Richardson \n              DR, \n            \n            \n              Willers \n              J, \n            \n            \n              Cohen \n              BE, \n            \n            et al: \n          Evaluation of the hallux morbidity of single-incision flexor hallucis longus tendon transfer. 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J Biomech42: 679, 2009.1928199210.1016\/j.jbiomech.2009.01.022"},{"key":"i8750-7315-109-4-282-b12","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1177\/107110070302400306","article-title":"Flexor hallucis longus transfer for chronic Achilles tendonosis","volume":"24","author":"Den Hartog \n              BD:","year":"2003","unstructured":"Den Hartog \n              BD: \n            \n          \n          Flexor hallucis longus transfer for chronic Achilles tendonosis. Foot Ankle Int24: 233, 2003.10.1177\/10711007030240030612793486"},{"key":"i8750-7315-109-4-282-b13","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"794","DOI":"10.3113\/FAI.2008.0794","article-title":"Treatment of chronic Achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings","volume":"29","author":"Hahn \n              F,","year":"2008","unstructured":"Hahn \n              F, \n            \n            \n              Meyer \n              P, \n            \n            \n              Maiwald \n              C, \n            \n            et al: \n          Treatment of chronic Achilles tendinopathy and ruptures with flexor hallucis tendon transfer: clinical outcome and MRI findings. Foot Ankle Int29: 794, 2008.10.3113\/FAI.2008.079418752777"},{"key":"i8750-7315-109-4-282-b14","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"305","DOI":"10.1177\/107110070102200406","article-title":"Treatment of stage II posterior tibial tendon dysfunction with flexor hallucis longus transfer and medial displacement calcaneal osteotomy","volume":"22","author":"Sammarco \n              GJ,","year":"2001","unstructured":"Sammarco \n              GJ, \n            \n            \n              Hockenbury \n              RT: \n            \n          \n          Treatment of stage II posterior tibial tendon dysfunction with flexor hallucis longus transfer and medial displacement calcaneal osteotomy. Foot Ankle Int22: 305, 2001.10.1177\/10711007010220040611354443"},{"key":"i8750-7315-109-4-282-b15","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"1286","DOI":"10.1177\/1071100713487724","article-title":"Plantar forces in flexor hallucis longus versus flexor digitorum longus transfer in adult acquired flatfoot deformity","volume":"34","author":"Spratley \n              EM,","year":"2013","unstructured":"Spratley \n              EM, \n            \n            \n              Arnold \n              JM, \n            \n            \n              Owen \n              JR, \n            \n            et al: \n          Plantar forces in flexor hallucis longus versus flexor digitorum longus transfer in adult acquired flatfoot deformity. Foot Ankle Int34: 1286, 2013.2361332810.1177\/1071100713487724"},{"key":"i8750-7315-109-4-282-b16","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1177\/107110070602700805","article-title":"Staged reconstruction for chronic rupture of both peroneal tendons using Hunter rod and flexor hallucis longus tendon transfer: a long-term follow up study","volume":"27","author":"Wapner \n              KL,","year":"2006","unstructured":"Wapner \n              KL, \n            \n            \n              Taras \n              JS, \n            \n            \n              Lin \n              SS, \n            \n            et al: \n          Staged reconstruction for chronic rupture of both peroneal tendons using Hunter rod and flexor hallucis longus tendon transfer: a long-term follow up study. Foot Ankle Int27: 591, 2006.1691921110.1177\/107110070602700805"},{"key":"i8750-7315-109-4-282-b17","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1177\/107110070302400903","article-title":"Flexor hallucis longus transfer for repair of chronic Achilles tendinopathy","volume":"24","author":"Tashjian \n              RZ,","year":"2003","unstructured":"Tashjian \n              RZ, \n            \n            \n              Hur \n              J, \n            \n            \n              Sullivan \n              RJ, \n            \n            et al: \n          Flexor hallucis longus transfer for repair of chronic Achilles tendinopathy. Foot Ankle Int24: 673, 2003.10.1177\/10711007030240090314524515"},{"key":"i8750-7315-109-4-282-b18","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1177\/107110070102200802","article-title":"Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for posterior tibial tendon dysfunction: a middle-term clinical follow-up","volume":"22","author":"Guyton \n              GP,","year":"2001","unstructured":"Guyton \n              GP, \n            \n            \n              Jeng \n              C, \n            \n            \n              Krieger \n              LE, \n            \n            et al: \n          Flexor digitorum longus transfer and medial displacement calcaneal osteotomy for posterior tibial tendon dysfunction: a middle-term clinical follow-up. Foot Ankle Int22: 627, 2001.1152702210.1177\/107110070102200802"},{"key":"i8750-7315-109-4-282-b19","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"445","DOI":"10.1177\/107110070402500701","article-title":"Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy","volume":"25","author":"Myerson \n              MS,","year":"2004","unstructured":"Myerson \n              MS, \n            \n            \n              Badekas \n              A, \n            \n            \n              Schon \n              LC: \n            \n          \n          Treatment of stage II posterior tibial tendon deficiency with flexor digitorum longus tendon transfer and calcaneal osteotomy. Foot Ankle Int25: 445, 2004.10.1177\/10711007040250070115319100"},{"key":"i8750-7315-109-4-282-b20","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.3113\/FAI.2008.1179","article-title":"Functional outcome after surgical reconstruction of posterior tibial tendon insufficiency in patients under 50 years","volume":"29","author":"Tellisi \n              N,","year":"2008","unstructured":"Tellisi \n              N, \n            \n            \n              Lobo \n              M, \n            \n            \n              O'Malley \n              M, \n            \n            et al: \n          Functional outcome after surgical reconstruction of posterior tibial tendon insufficiency in patients under 50 years. Foot Ankle Int29: 1179, 2008.1913848010.3113\/FAI.2008.1179"},{"key":"i8750-7315-109-4-282-b21","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"363","DOI":"10.1177\/107110070602700508","article-title":"An in vitro study comparing the use of suture anchors and drill hole fixation for flexor digitorum longus transfer to the navicular","volume":"27","author":"Sullivan \n              RJ,","year":"2006","unstructured":"Sullivan \n              RJ, \n            \n            \n              Gladwell \n              HA, \n            \n            \n              Aronow \n              MS, \n            \n            et al: \n          An in vitro study comparing the use of suture anchors and drill hole fixation for flexor digitorum longus transfer to the navicular. Foot Ankle Int27: 363, 2006.10.1177\/107110070602700508"},{"key":"i8750-7315-109-4-282-b22","series-title":"Ann Anat","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1016\/j.aanat.2015.11.008","article-title":"Anatomical study of toe flexion by flexor hallucis longus","volume":"204","author":"Edama \n              M,","year":"2016","unstructured":"Edama \n              M, \n            \n            \n              Kubo \n              M, \n            \n            \n              Onishi \n              H, \n            \n            et al: \n          Anatomical study of toe flexion by flexor hallucis longus. Ann Anat204: 80, 2016.10.1016\/j.aanat.2015.11.00826704354"},{"key":"i8750-7315-109-4-282-b23","series-title":"Clin Anat","doi-asserted-by":"publisher","first-page":"768","DOI":"10.1002\/ca.21170","article-title":"An anatomic study of the quadratus plantae in relation to tendinous slips of the flexor hallucis longus for gait analysis","volume":"24","author":"Hur \n              MS,","year":"2011","unstructured":"Hur \n              MS, \n            \n            \n              Kim \n              JH, \n            \n            \n              Woo \n              JS, \n            \n            et al: \n          An anatomic study of the quadratus plantae in relation to tendinous slips of the flexor hallucis longus for gait analysis. Clin Anat24: 768, 2011.2181203310.1002\/ca.21170"},{"key":"i8750-7315-109-4-282-b24","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"528","DOI":"10.1177\/107110070602700708","article-title":"Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons","volume":"27","author":"LaRue \n              BG,","year":"2006","unstructured":"LaRue \n              BG, \n            \n            \n              Anctil \n              EP: \n            \n          \n          Distal anatomical relationship of the flexor hallucis longus and flexor digitorum longus tendons. Foot Ankle Int27: 528, 2006.1684272010.1177\/107110070602700708"},{"key":"i8750-7315-109-4-282-b25","series-title":"J Anat","first-page":"437","article-title":"Observations on the muscles and tendons of the medial aspect of the sole of the foot","volume":"98","author":"Martin \n              BF:","year":"1964","unstructured":"Martin \n              BF: \n            \n          \n          Observations on the muscles and tendons of the medial aspect of the sole of the foot. J Anat98: 437, 1964.14193201"},{"key":"i8750-7315-109-4-282-b26","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"910","DOI":"10.3113\/FAI.2007.0910","article-title":"Risk of neurovascular injuries in flexor hallucis longus tendon transfers: an anatomic cadaver study","volume":"28","author":"Mulier \n              T,","year":"2007","unstructured":"Mulier \n              T, \n            \n            \n              Rummens \n              E, \n            \n            \n              Dereymaeker \n              G: \n            \n          \n          Risk of neurovascular injuries in flexor hallucis longus tendon transfers: an anatomic cadaver study. Foot Ankle Int28: 910, 2007.10.3113\/FAI.2007.091017697656"},{"key":"i8750-7315-109-4-282-b27","series-title":"JAPMA","first-page":"166","article-title":"Communication of contrast in the flexor hallucis longus tendon with other pedal tendons at the master knot of Henry","volume":"107","author":"Ali \n              S,","year":"2017","unstructured":"Ali \n              S, \n            \n            \n              Griffin \n              NL, \n            \n            \n              Ellis \n              W, \n            \n            et al: \n          Communication of contrast in the flexor hallucis longus tendon with other pedal tendons at the master knot of Henry. JAPMA107: 166, 2017."},{"key":"i8750-7315-109-4-282-b28","series-title":"Foot Ankle Int","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1177\/107110070302401211","article-title":"Flexor hallucis longus tendon transfer: evaluation of post operative morbidity","volume":"24","author":"Coull \n              R,","year":"2003","unstructured":"Coull \n              R, \n            \n            \n              Flavin \n              R, \n            \n            \n              Stephens \n              MM: \n            \n          \n          Flexor hallucis longus tendon transfer: evaluation of post operative morbidity. Foot Ankle Int24: 931, 2003.10.1177\/107110070302401211"},{"key":"i8750-7315-109-4-282-b29","series-title":"Clin Biomech","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1016\/j.clinbiomech.2007.08.015","article-title":"Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus transfer","volume":"23","author":"Hahn \n              F,","year":"2008","unstructured":"Hahn \n              F, \n            \n            \n              Maiwald \n              C, \n            \n            \n              Horstmann \n              T, \n            \n            et al: \n          Changes in plantar pressure distribution after Achilles tendon augmentation with flexor hallucis longus transfer. 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