Three-dimensional architecture of the great toe muscles: functional implications in hallux valgus

Abstract

Objectives: Imbalance of great toe musculature has been identified as a factor in the development of hallux valgus. The musculoaponeurotic architecture, an important determinant of function, has not been investigated volumetrically in the great toe musculature. The purpose of this study was to reconstruct the abductor halluces (ABDH), adductor halluces (ADH), flexor hallucis brevis medial (FHBM) and lateral (FHBL) heads volumetrically and to quantify and compare their architectural parameters and functional characteristics. Methods: Ten formalin-embalmed specimens were dissected, digitized and modelled (Autodesk Maya®). Fiber bundle length (FBL) and physiological cross-sectional area (PCSA) of the muscles were compared using descriptive and parametric statistics. Results: The spatial arrangement of aponeuroses (AP) / fiber bundles (FB) and architectural parameters varied throughout the volume of each muscle. The PCSA of the medial (ABDH/FHBM) and lateral (ADH/FHBL) musculature was similar; however, the medial musculature had significantly greater mean FBL. Conclusion: Each muscle had varying AP/FB arrangement. The similar PCSA of the medial and lateral musculature suggests that their relative force generating capabilities are balanced in asymptomatic individuals.

Keywords

• fiber bundle lenght
• great toe
• hallux valgus
• muscle architecture
• PCSA
• pennation angle
• volume

References

1. Nix S, Smith M, Vicenzino B. Prevalence of hallux valgus in the general population: a systematic review and meta-analysis. J Foot Ankle Res 2010;3:21.
2. Dykyj D. Pathologic anatomy of hallux abducto valgus. Clin Podiatr Med Surg 1989;6:1–15.
3. Hoffmeyer P, Cox JN, Blanc Y, Meyer JM, Taillard W. Muscle in hallux valgus. Clin Orthop Relat Res 1988;(232):112–8.
4. Perera AM, Mason L, Stephens MM. The pathogenesis of hallux valgus. J Bone Joint Surg Am 2011;93:1650–61.
5. Incel NA, Genc H, Erdem HR, Yorgancioglu ZR. Muscle imbalance in hallux valgus: an electromyographic study. Am J Phys Med Rehabil 2003;82:345–9.
6. Iida M, Basmajian JV. Electromyography of hallux valgus. Clin Orthop Relat Res 1974;(101):220–4.
7. Mortka K, Lisiƒski P, Wiertel-Krawczuk A. The study of surface electromyography used for the assessment of abductor hallucis muscle activity in patients with hallux valgus. Physiother Theory Pract 2018;34:846–51. 84.
8. Lieber RL, Ward SR. Skeletal muscle design to meet functional demands. Philos Trans R Soc Lond B Biol Sci 2011;366:1466–76.

9. Castanov V, Hassan SA, Shakeri S, Vienneau M, Zabjek K, Richardson D, McKee NH, Agur AMR. Muscle architecture of vastus medialis obliquus and longus and its functional implications: a three-dimensional investigation. Clin Anat 2019;32:515–23.
10. Li Z, Mogk JPM, Lee D, Bibliowicz J, Agur AM. Development of an architecturally comprehensive database of forearm flexors and extensors from a single cadaveric specimen. Comput Methods in Biomechanics and Biomedical Engineering: Imaging and Visualizaton 2015;3:3–12.
11. Shaw SM, Martino R, Mahdi A, Sawyer FK, Mathur S, Hope A, Agur AM. Architecture of the suprahyoid muscles: avolumetric musculoaponeurotic analysis. J Speech Lang Hear Res 2017;60:2808–18.
12. Kura H, Luo ZP, Kitaoka HB, An KN. Quantitative analysis of the intrinsic muscles of the foot. Anat Rec 1997;249:143–51.
13. Silver RL, de la Garza J, Rang M. The myth of muscle balance. A study of relative strengths and excursions of normal muscles about the foot and ankle. J Bone Joint Surg Br 1985;67:432–7.
14. Tosovic D, Ghebremedhin E, Glen C, Gorelick M, Mark Brown J. The architecture and contraction time of intrinsic foot muscles. J Electromyogr Kinesiol 2012;22:930–8.
15. Lachowitzer MR, Ranes A, Yamaguchi GT. Musculotendon parameters and musculoskeletal pathways within the human foot. J Appl Biomech 2007;23:20–41.
16. Ledoux WR, Hirsch BE, Church T, Caunin M. Pennation angles of the intrinsic muscles of the foot. J Biomech 2001;34:399–403.
17. Cralley JC, McGonagle W, Fitch K. The role of adductor hallucis in bunion deformity: part I. J Am Podiatry Assoc 1976;66:910–8.
18. Glasoe WM, Nuckley DJ, Ludewig PM. Hallux valgus and the first metatarsal arch segment: a theoretical biomechanical perspective. Phys Ther 2010;90:110–20.
19. Wong YS. Influence of the abductor hallucis muscle on the medial arch of the foot: a kinematic and anatomical cadaver study. Foot Ankle Int 2007;28:617–20.
20. Headlee DL, Leonard JL, Hart JM, Ingersoll CD, Hertel J. Fatigue of the plantar intrinsic foot muscles increases navicular drop. J Electromyogr Kinesiol 2008;18:420–5.
21. Farris DJ, Kelly LA, Cresswell AG, Lichtwark GA. The functional importance of human foot muscles for bipedal locomotion. Proc Natl Acad Sci U S A 2019;116:1645–50.
22. Kelly LA, Cresswell AG, Racinais S, Whiteley R, Lichtwark G. Intrinsic foot muscles have the capacity to control deformation of the longitudinal arch. J R Soc Interface 2014;11:20131188.
23. Kelikian AS. Sarrafian’s anatomy of the foot and ankle: descriptive, topographic, functional. 3rd ed. Philadephia (PA): Wolters Kluwer Health; 2011. 736 p.
24. Martin BF. Observations on the muscles and tendons of the medial aspect of the sole of the foot. J Anat 1964;98:437–53. 25. Tas S, Cetin A. Mechanical properties and morphologic features of intrinsic foot muscles and plantar fascia in individuals with hallux valgus. Acta Orthop Traumatol Turc 2019;53:282–6.
25. Tas S, Cetin A. Mechanical properties and morphologic features of intrinsic foot muscles and plantar fascia in individuals with hallux valgus. Acta Orthop Traumatol Turc 2019;53:282–6.