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A Novel Approach to Flexor Hallucis Longus Tenography

Michael S. Gelbart1, Ashesh Parikh2, Wincha Chong2 and Louis A. Gilula2

1 Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S. Kingshighway Blvd., St. Louis, MO 63110.
2 Washington University School of Medicine, St. Louis, MO 63110.


Figure 1
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  		Fig. 1A —MR images show relationship of flexor tendons to each other, sustentaculum talus, and neurovascular bundle in 35-year-old man. Axial T1 = weighted (TR/TE, 500/15) weighted image of ankle at level of midportion of sustentaculum talus (star). Neurovascular bundle (gray arrow) shown anteromedial to flexor hallucis longus (long arrow) tendon at level of sustentaculum talus. Posterior tibialis tendon (short, thick arrow) and flexor digitorum longus tendon (short, thin arrow) are shown.

 

Figure 2
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  		Fig. 1B —MR images show relationship of flexor tendons to each other, sustentaculum talus, and neurovascular bundle in 35-year-old man. Coronal T1 = weighted (TR/TE, 500/15) weighted image of ankle at level of sustentaculum talus (star) and mid subtalar facet joint. Flexor hallucis longus tendon (long arrow), posterior tibialis tendon (short, thick arrow), and flexor digitorum longus tendon (short, thin arrow) are shown.

 

Figure 3
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  		Fig. 1C —MR images show relationship of flexor tendons to each other, sustentaculum talus, and neurovascular bundle in 35-year-old man. Sagittal T1 = weighted (TR/TE, 500/15) weighted image of ankle at level of sustentaculum talus (star). Flexor hallucis longus (arrow) is shown.

 

Figure 4
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  		Fig. 2A —Fluoroscopy of a 41-year-old woman. Lateral view of foot with under surface of sustentaculum talus (arrows) in profile. Tip of metal clamp points to undersurface of sustentaculum talus.

 

Figure 5
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  		Fig. 2B —Fluoroscopy of a 41-year-old woman. Twenty-five-gauge, 1-inch (2.54-mm) needle (white arrow) passed in a "bull's-eye" fashion to midportion of the undersurface of sustentaculum talus (black arrows).

 

Figure 6
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  		Fig. 2C —Fluoroscopy of a 41-year-old woman. Contrast material fills flexor hallucis longus (FHL) (arrows) tendon sheath.

 

Figure 7
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  		Fig. 2D —Fluoroscopy of a 41-year-old woman. Frontal view shows FHL tendon sheath passing over midportion of ankle (arrows), expected position of FHL tendon sheath posteriorly.

 

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