0:00

Moving on.

0:01

Um, if you notice, and we can stay on this plane here, we

0:04

of course have the flexor and extensor attendants.

0:08

So the flexor and extensor tendon, uh, are going to be going

0:12

to their destinations to the toes.

0:14

Um, what we can see here is that there's an extensor tendon,

0:17

extensor house's tendon going to the base of the first,

0:21

uh, distal phx.

0:24

Remember that in order to extend

0:25

and flex each, um, each joint, you have to have a tendon

0:29

that will go to those joints.

0:30

Uh, so that's kind of how I think about it.

0:32

So you can see here the, uh,

0:34

extensor Hal's brevis will then go to the, uh, base

0:37

of the proximal phx.

0:38

On the flexor side, you have a flexor tendon

0:41

that's going all the way to the tip of the, uh, not

0:45

to the tip, but to the, uh, distal phalanx.

0:47

It's a flexor house as long as,

0:49

and each of the toes are gonna have an extensor tendon

0:53

and a flexor tendon.

0:55

So you wanna make sure that those are intact.

0:56

Usually, uh, you are not gonna find a rupture

0:59

unless there's a good history.

1:01

Occasionally have a patient who's had, uh, who has a more

1:05

of a clinically occult rupture,

1:07

and they may present with a mass

1:08

and you might see a bald up tendon,

1:11

or you might see teno synovitis.

1:12

So look at those tendons as well.

1:15

Look at them on the short axis,

1:17

which is a really nice view for me.

1:19

I like to look at the fortino synovitis.

1:21

So in the short axis, you can see the extensor tendons

1:25

as these little black dots here and the flexor tendons.

1:28

So you can scroll through. I look Fortino synovitis.

1:31

I look to make sure that they are in the

1:33

midline, that they're attached.

1:34

Uh, they, they're, uh, aligned

1:36

with their respective ray here.

1:39

One thing to note for the flexor lysis, uh,

1:42

longest is the flexor for the great toe, is that it does,

1:45

has an interesting, uh, course.

1:47

So you'll see the flexor lysis here.

1:49

And when you get to that hallex sesame complex,

1:51

which we're gonna go into more detail in a minute,

1:53

you're gonna see that the flexor house, as long as

1:58

the FHL is right in the middle, it's in the middle

2:01

between the two sesamoids.

2:03

That's a good landmark. So the, the flexor house, as long

2:07

as is gonna go right between the sesamoids

2:10

and it's actually just superficial to this structure,

2:12

which is the intermodal ligament.

2:16

And, um, you're gonna follow that,

2:19

make sure it's in the midline.

2:20

It's gonna keep going all the way to the distal failings.

2:27

When you look on a little bit further back, you're gonna see

2:34

multiple muscle groups.

2:36

Um, when you're reading emr, you do want

2:40

to take a look at those and you do want

2:41

to comment if there's any atrophy or edema.

2:44

Um, on the extensor side,

2:46

you have extended digitorum muscles.

2:48

On the flexor side, you're gonna have the abductor

2:52

lysis muscles.

2:53

You're gonna have, um, and we'll go over that in detail.

2:56

You're gonna have brevis and longus. You're gonna

2:58

Have the extensor digitorum brevis muscles just deep to

3:02

that quadratus planty.

3:04

And on the outer side, the lateral side,

3:06

you're gonna have the abductor digi minimi.

3:09

If you have Baxter's neuropathy, right,

3:11

which is basically kind of an impingement

3:13

of the first branch off the lateral plantar nerve,

3:18

you might have atrophy

3:19

and fat infiltration of the, um, abductor digi immune.

3:23

So that's one thing you can look

3:24

for like the short axis for that.

3:29

Remember that the plantar fascia keeps going.

3:30

So this is not at the heel,

3:31

but of course you still see the plantar fascia.

3:33

That's type one, two structure here.

3:35

And the plantar fascia has the three cords.

3:38

We talked about the lateral cord as sort

3:40

of this lesser discussed, uh, part of the plantar fascia

3:43

that will go to the base of the fifth.

3:45

And then we have the central cord

3:47

and the medial cord as well.