Introduction: The purpose of this cadaver study was to test feasibility and safety of a new technique for harvesting the FDL tendon through a plantar incision placed directly overlying the FDL division and to define the relevant surgical anatomy.

Materials and Methods: In eight cadaver feet the FDL tendon was exposed in the midfoot through a plantar incision. The FDL tendon was divided and pulled proximally through a wound in the hindfoot. All the tissues superficial to the FDL tendon were then reflected to check for any inadvertent damage to adjacent neurovascular structures.

Results: The FDL division lies midway between the back of the heel and the base of the second toe and about 3.7 cm medial to the lateral border of the foot. The medial and the lateral plantar neurovascular bundles are respectively about 0.43 cm and 0.86 cm away from the FDL division.

Conclusions: The FDL tendon can be harvested through a plantar incision. The adjacent neurovascular structures remained undamaged. Plantar surface anatomy guides placement of the plantar incision so that the incision can overlie directly over the FDL division.

Introduction: Hallux valgus (HV) deformity increases width of the forefoot. Criteria for a successful outcome after surgery include resolution of pain, a narrower forefoot and ability to wear conventional shoes. Skeletal width of the forefoot can be objectively measured on radiographs by a recently introduced parameter called the metatarsal span (MS). Reduction in MS can therefore be used as an outcome indicator. It is however not known if MS can be measured reliably. It is hypothesized that MS which is a linear parameter can be measured as reliably as the HV and intermetatarsal (IM) angular parameters.

Methods: Digitized pre and postoperative weight bearing radiographs of twenty patients with HV were evaluated by six observers. HV and IM angles and the MS were measured using digital techniques. ANOVA was used to study inter-observer and intra-observer reliability. A 95% confidence interval was determined.

Results: Inter and intra-observer agreement was present for all measurements. 95% CI for intra-observer pre and post operative measurements were ± 5° and ± 5° for HV angle, ±2° and ± 3° for IM, and ± 1.0mm and ± 3.0mm for MS. 95% CI inter-observer pre and post operative measurements were ± 4° and ± 4° for HV angle, ± 3° and ± 2° for IM angle, and ± 1.0mm and ± 2.1 mm for forefoot width, respectively.

Conclusion: Digital measurements of the linear parameter MS can be obtained as reliably as angular parameters HV and IM angles.

One of the criteria associated with success after hallux valgus surgery is reduction of the forefoot width. A new parameter called the metatarsal span can be a reliable objective measure to assess reduction of forefoot width and outcome after surgery for hallux valgus.