Why must the ankle be in neutral position when suturing the FHL and FDL together during a tibialis posterior reconstruction?

Why must the ankle be in neutral position when suturing the FHL and FDL together during a tibialis posterior reconstruction?

• A. It will cause hammertoes if not in neutral
• B. It will cause foot drop
• C. It increases ankle stiffness
• D. It lengthens the flexor tendons

Answer: (A)

Stability of tendon tension depends on the angle of the ankle when you set the grafts. When reconstructing the tibialis posterior using slips of the FHL and FDL, you’re re-establishing a balanced arch-supporting pull. If the ankle isn’t in neutral during suturing, the length and tension of those transferred tendons will be set at an abnormal angle. That means, after healing, the toes can be pulled into a flexed position more than intended, which can lead to toe deformities such as hammer toes as the foot moves through gait. Placing the ankle in neutral gives a balanced, physiologic length-tension relationship for the grafts in the resting position, so the toe flexors aren’t chronically over-tensioned or under-tensioned. This helps maintain proper toe alignment and reduces the risk of developing hammertoes postoperatively.

Stability of tendon tension depends on the angle of the ankle when you set the grafts. When reconstructing the tibialis posterior using slips of the FHL and FDL, you’re re-establishing a balanced arch-supporting pull. If the ankle isn’t in neutral during suturing, the length and tension of those transferred tendons will be set at an abnormal angle. That means, after healing, the toes can be pulled into a flexed position more than intended, which can lead to toe deformities such as hammer toes as the foot moves through gait.

Placing the ankle in neutral gives a balanced, physiologic length-tension relationship for the grafts in the resting position, so the toe flexors aren’t chronically over-tensioned or under-tensioned. This helps maintain proper toe alignment and reduces the risk of developing hammertoes postoperatively.