Dorsal Approach to Transfer of the Flexor Digitorum Brevis Tendon

Background: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammer toe deformities. Only transposition of the flexor digitorum brevis tendon has been reported in the literature in a cadaveric study that used the dorsal and plantar approach. A search of the literature revealed no reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions through a unique dorsal cutaneous incision. We performed a cadaveric study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique dorsal cutaneous incision. Methods: Transposition of the flexor digitorum brevis tendon was attempted in 156 toes of cadaveric feet (52 each second, third, and fourth toes) through a unique dorsal incision. Results: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes by the dorsal incision approach. Conclusions: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammer toe deformities, especially in the second, third, and fourth toes. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon is essential to the success of the procedure. (J Am Podiatr Med Assoc 101(4): 297-306, 2011) Hammer toe is a toe deformity characterized by dorsiflexion of the metatarsophalangeal joint, plantarflexion of the proximal interphalangeal joint, and dorsiflexion of the distal interphalangeal joint. Claw toe is a similar deformity characterized by dorsiflexion of the metatarsophalangeal joint and plantarflexion of the proximal and distal interphalangeal joints. These terms are often used interchangeably