Mode of insertion of the abductor hallucis muscle in human feet and its arterial supply

Abstract

The abductor hallucis flap is commonly used as a pedicled flap (distally or proximally based) in the management of ankle, heel, and mid-foot lesions, where it is ideally used for closing defects. This study investigates the anatomical details of this muscle regarding its various forms of insertion and its arterial supply in 15 cadaveric feet. Four types of insertion could be distinguished: type A, insertion at the proximal phalanx of the big toe (46.7%); type B, insertion by two slips into the base of the proximal phalanx and the sesamoid bone (33.3%); type C, insertion at the sesamoid bone (6.7%); And type D, the insertion is divided into superficial tendinous and deep fleshy parts which are attached to the base of the proximal phalanx and to the metatarsophalangeal joint capsule of the big toe, respectively (13.3%). As regards the arterial supply, three patterns were noticed: pattern A (40%) where the medial plantar artery (MPA) is divided into superficial and deep branches that supplied the muscle; pattern B (53.3%) where the MPA failed to produce a deep branch but instead continued as the superficial branch supplying the two ends of the muscle; and pattern C (6.6%) where the MPA continued as a deep branch supplying the muscle. A superficial branch of MPA provided a branch to the abductor hallucis muscle from its proximal part. In two specimens (13.3%), the lateral plantar artery shared in the supply of the most proximal part of the muscle. These results can be useful in determining the appropriate flap design based on the abductor hallucis type of insertion and the pattern of its arterial supply in the patients.
Folia Morphol 2010; 69, 1: 54-61