How To Tell If You Are Lost

It is impossible to get lost if you come down the midline. If you are too proximal or distal, you will still run into the tendon. If you go proximally too far, you will be in the fat of the metatarsal fat pad. If you are distal to the proximal interphalangeal joint, you will not see the short flexor tendon (which is identical to the sublimis of the hand).

FIGURE 55—1 The skin incision over the proximal phalanx.

FIGURE 55—2 The retractor in place, which holds the neurovascular bundle away from the tendon sheath in the midline.

FIGURE 55—3 The tendon sheath open. On the side is seen the medial slip of the flexor digitorum brevis. The flexor digitorum longus is more superficial. Notice it has a split in its mid-portion, which is frequently seen. This split should not confuse you into thinking that you have identified the lateral tendon of the flexor digitorum brevis. At this level, these two tendons are identical to the arrangement in the hand between the sublimis and profundis. If you are doing a toe flexor release and you leave the branch of the flexor digitorum brevis tendon uncut, the patient will have a persisting deformity.

D Flexor Tendon Sheath

El Tendon Sheath Overlying Lateral Slip of Flexor Digitorum Brevis D Flexor Digitorum Brevis Medial Slip D Flexor Digitorum Longus

FIGURE 55—3 The tendon sheath open. On the side is seen the medial slip of the flexor digitorum brevis. The flexor digitorum longus is more superficial. Notice it has a split in its mid-portion, which is frequently seen. This split should not confuse you into thinking that you have identified the lateral tendon of the flexor digitorum brevis. At this level, these two tendons are identical to the arrangement in the hand between the sublimis and profundis. If you are doing a toe flexor release and you leave the branch of the flexor digitorum brevis tendon uncut, the patient will have a persisting deformity.

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