Anatomy Of The Flexor Digitorum Longus Muscle - Everything You Need To Know - Dr. Nabil Ebraheim

Dr. Ebraheim’s educational animated video describes the anatomy of the flexor digitorium muscle.

It arises from the posterior surface of the midtibia immediately below the soleal line and medial to the tibial origin of the tibialis posterior. It is medial to an imaginary vertical line that separates the tibialis anterior muscle from the flexor digitorum longus. The tendon of the flexor digitorum longus passes behind the medial malleolus in a groove. This groove also contains the tendon of the tibialis posterior.
Here is a mnemonic phrase used in memorizing the order of the artery, the nerve and the three tendons of the flexor retinaculum in the lower leg: the T, D a, n, and H of Tom, Dick and Harry correspond to tibialis posterior, flexor digitorum longus, posterior tibial artery, tibial nerve and flexor hallucis longus.
After the tendons curve under the medial malleolus and talus, they begin to converge and then cross each other. The flexor hallucis longus tendon is crossed deep to the flexor digitorum longus tendon into the medial compartment of the foot. The flexor digitorum longus tendon becomes more plantar (superficial). The two tendons are connected by a strong tendinous slip. Tibialis posterior tendon insufficiency or rupture is not uncommon and may be missed. When insufficiency or rupture is diagnosed, one of the treatment options is to borrow the tendon next to the tibialis posterior tendon in order to reinforce the function of the tibialis posterior. The logical choice of tendons is the one next to the tibialis posterior tendon, the flexor digitorum longus tendon (FDL). Used as a tendon transfer, not alone but in conjunction with other procedures, usually bony procedures. Because of the intersection between the flexor hallucis longus and the flexor digitorum longus tendons, if transection and transfer of the flexor digitorum longus tendon is done proximal to the knot of henry to correct the tibialis posterior dysfunction, this will result in retention of the function of the big toe and the lesser toes. Crossing of these two tendons at the knot of henry is a good thing.
Flexor means in the sole (bottom) of the foot. Digitorum means going to the toes. Longus means longer, the tendon needs to reach the four lateral toes. The tendon of the flexor digitorum longus expands and is joined by the quadratus plantae muscle. It then divides into four tendons that are inserted into the base of the distal phalanges of the second, third, fourth and fifth toes. Remember, tendons are inserted into the plantar surface of the distal phalanges (2nd, 3rd, 4th and 5th).
It flexes the 2nd, 3rd, 4th, and 5th toes. It also aids in plantar flexion of the ankle.
Remember, in case of posterior tibial tendon insufficiency or rupture, the flexor digitorum longus tendon transfer is used in combination with calcaneal osteotomy, Achilles tendon lengthening, plus or minus lateral column lengthening. The arrangement of the tendons at the medial ankle.

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