Hello all,

Sorry to be jumping in a bit late on this one but I
have an interesting observation that I have not yet
seen addressed.  I know from the literature and my own
observations of plantar pressures post HAV surgery
that hallux peak pressure is often reduced to a
significant extent.  This clearly indicates a
reduction in flexor halluces longus (FHL) tension. 
Guarding, over-lengthening, over-shortening, or any of
several other factors may be responsible for this. 
Any way you look at it, I feel confident in asserting
that the tension is reduced for months if not
permanently.  Proper post-operative physical therapy
and orthoses management certainly can help.

My point is this:  consider the course of the FHL.  It
generally passes around a trochlear surface on the
posterior medial aspect of the talus.  This is medial
to the STJ and therefore has the potential to cause an
external rotation moment about that joint.  While the
force would be rather close to the STJ axis, the FHL
is a fairly strong muscle.

I believe that the FHL plays a very important role in
resisting pronation about the STJ and perhaps even in
resupination.  This is not revolutionary howeve, I
have yet to find literature that clearly addresses
this from the point of FHL contact with the talus.  If
anyone has, please let me know.  Certainly the FHL has
been studied in its supinatory force with hallux
loading.  I feel confident that data I have collected
with both the "dynamic gait replicator" and my static
frame supports this contention.  I plan to publish
this as soon as I have the time to put the article
together.

Most podiatric surgeons are aware of a tendency toward
the development of an elevatus of the medial column
post HAV surgery.  Surgeon skill and appropriate
choice of procedure obviously reduce this sequela. 
Resultant decrease in plantar 1st MTPJ is easily one
of the most direct theories for transferal of force to
the second MTPJ.  

In reviewing years of serial radiographs, I see
several common patterns.  Eventual elevatus may occur
with base, distal, and Keller-type procedures.  It can
be seen to develop even years down the road in cases
that were initially well aligned.  Could this be
partly due to a compromise in FHL function?  Does
anyone have any thoughts on the matter?

Respectfully,

Jay


	
        	
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