ORIGINAL ARTICLES Dorsal Approach to Transfer of the Flexor Digitorum Brevis Tendon Ricardo Becerro de Bengoa Vallejo, DPM, PhD* Marta Elena Losa Iglesias, PhD† Juan Carlos Prados Frutos, MD‡ Miguel Fuentes Rodriguez, PhD* Kevin T. Jules, DPM§ Background: Transposition of the flexor digitorum longus tendon has been widely reported for the correction of flexible claw and hammer toe deformities. Only transposition of the flexor digitorum brevis tendon has been reported in the literature in a cadaveric study that used the dorsal and plantar approach. A search of the literature revealed no reports of transposition of the flexor digitorum brevis tendon for treatment of these conditions through a unique dorsal cutaneous incision. We performed a cadaveric study to determine whether the flexor digitorum brevis tendon is long enough to be transferred to the dorsum of the proximal phalanx of the toe from its lateral or medial aspect through a unique dorsal cutaneous incision. Methods: Transposition of the flexor digitorum brevis tendon was attempted in 156 toes of cadaveric feet (52 each second, third, and fourth toes) through a unique dorsal incision. Results: The flexor digitorum brevis tendon was long enough to be successfully transposed in 100% of the second, third, and fourth toes by the dorsal incision approach. Conclusions: Transfer of the flexor digitorum brevis tendon to the dorsum of the proximal phalanx can be performed for the correction of claw and hammer toe deformities, especially in the second, third, and fourth toes. The meticulous longitudinal incision of the flexor tendon sheath to expose the flexor digitorum brevis tendon is essential to the success of the procedure. (J Am Podiatr Med Assoc 101(4): 297-306, 2011) Hammer toe is a toe deformity characterized by dorsiflexion of the metatarsophalangeal joint, plan- tarflexion of the proximal interphalangeal joint, and dorsiflexion of the distal interphalangeal joint. Claw toe is a similar deformity characterized by dorsi- flexion of the metatarsophalangeal joint and plan- tarflexion of the proximal and distal interphalangeal joints. These terms are often used interchangeably because both types of deformity involve the metatarsophalangeal joint. In 1969, Sarrafian and Topouzian 1 demonstrated on cadavers that the common extensor tendon of the toes, or the extensor digitorum longus tendon, has an extensor action on the distal and proximal interphalangeal joints only when the proximal phalanx is held in plantarflexion through the action of the intrinsic or short musculature of the foot. Sandeman 2 reported that when the proximal pha- lanx is in the dorsal position at the expense of metatarsophalangeal joint dorsiflexion, the axis of the intrinsic muscles shifts, causing a loss of competence of the intrinsic musculature of the foot, which, in turn, loses its capacity to maintain the proximal phalanx in a plantar position. When this happens and the flexor digitorum longus (FDL) tendon contracts, there is greater contraction of the intrinsic musculature, which loses its ability to *Escuela Universitaria de Enfermerı´a, Fisioterapia y Podo- logı´a, Universidad Complutense de Madrid, Madrid, Spain. †Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, Madrid, Spain. ‡Department of Anatomy and Embryology, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain. §Department of Surgical Sciences, New York College of Podiatric Medicine, New York, NY. Corresponding author: Ricardo Becerro de Bengoa Vallejo, DPM, PhD, Escuela Universitaria de Enfermerı ´a, Fisioterapia y Podologı´a, Universidad Complutense de Madrid, 28040 Madrid, Spain. (E-mail: ribebeva@teleline.es) Journal of the American Podiatric Medical Association  Vol 101  No 4  July/August 2011 297