Double Tendons at the Distal Attachment of the Extensor Hallucis Longus Muscle

The distal attachments of the extensor hallucis longus (EHL) tendons in 47 amputated legs and in eight cadavers were examined. The EHL had two tendons in 34 of the amputated legs and bilaterally in five cadavers. The lateral tendon was inserted to the middle of the dorsal aspect of the base of the distal phalanx of the hallux and the medial tendon to the medial side of the insertion of the lateral tendon. The length and thickness of these two tendons were measured and compared in order to obtain data for using these tendons in tendon repair and hallux varus corrections by autogenous tendon transfer surgery. Additionally, on the right foot of one of the cadavers, it was observed that the extensor hallucis brevis tendon united with the lateral tendon of the EHL. We recommend that foot-ankle surgeons be aware of the various accessory EHL tendons and their potential use in problematic cases.