Abstract
Introduction
The aim of this study is to better understand the anatomy of the forefoot to minimise surgical complications following minimally invasive forefoot surgery.
Methods
The study examines the plantar anatomy of the lesser toes in ten cadaver feet. The tendons, nerves and bony anatomy are recorded.
Results
The anatomy of the flexor tendons reveals the short flexor tendon bifurcates to allow the long flexor tendon to pass through it reliably at the level of the metatarsophalangeal joint (MTPJ) in the lesser rays. The division of the intermetatarsal nerves to digital nerves relative to the MTPJ is more variable. This nerve division is more consistently related to the skin of the web between the toes. In the first webspace the division is on average 3cm proximal to the skin at the deepest part of the cleft. In the second, third and fourth webspaces this distance is reduced to 1cm. The level of the deepest part of the webspace to the MTPJ is also variable.
Discussion
Surgical release of the flexor tendons is recommended just proximal to the MTPJ for releasing both tendons and distal to the proximal interphalangeal joint for the long flexor tendon. The webspace skin and MTPJ's are easily identifiable landmarks clinically and radiologically. Awareness of the intermetatarsal nerve division will help to reduce nerve injuries with minimally invasive surgery to the plantar forefoot.
