Lateral to the abductor hallucis is the flexor hallucis brevis, which originates from the medial cuneiform bone and from the tendon of the tibialis posterior. The flexor hallucis has a medial and a lateral head inserted laterally to the abductor hallucis. It is an important plantar flexor which comes into prominent use in classical ballet (i.e. for pointe work). The adductor hallucis has two heads; a stronger oblique head which arises from the cuboid and lateral cuneiform bones and the bases of the second and third metatarsals; and a transverse head which arises from the distal ends of the third-fifth metatarsals. Both heads are inserted on the lateral sesamoid bone of the first digit. The muscle acts as a tensor to the arches of the foot, but can also adduct the first digit and plantar flex its first phalanx.The opponens digiti minimi originates from the long plantar ligament and the plantar tendinous sheath of the fibularis (peroneus) longus and is inserted on the fifth metatarsal. When present, it acts to plantar flex the fifth digit and supports the plantar arch. The flexor digiti minimi arises from the region of base of the fifth metatarsal and is inserted onto the base of the first phalanx of the fifth digit where it is usually merged with the abductor of the first digit. It acts to plantar flex the last digit. The largest and longest muscles of the little toe is the abductor digiti minimi.
Diagnosis
IF tumors have features which overlap other types of fasciitis disorders such as proliferative fasciitis and nodular fasciitis. However, the age, history of debilitation, tumor location over boney protuberances, and tumor histopathology of having two distinctly different zones tend to distinguish IF from these two as well as the following tumors. Decubitus ulcers, i.e. common bed sores, differ from IF in typically having extensive ulcerations of the skin and histopathological evidence of acute inflammation as determined by the presence of various types of white blood cells. IF has also been mistaken for epithelioid sarcoma and elastofibroma dorsi. IF differs form epithelioid sarcoma by its clinical presentation, typical tumor cell morphology, i.e. round cells with atypical nuclei and eosinophilic cytoplasm, and complete or relative lack of necrotic areas. Elastofibroma dorsi is distinguished from IF by its abundant content of elastic fibers. Treatment
IF tumors are commonly treated by surgical excision although in rare cases these tumors have recurred at the site of their removal. Recurrent tumors have been treated by repeated surgical excisions. Since IF tumors have not been reported to metastasize and no deaths have been attributed to it, long-term clinical observation without surgical intervention is a reasonable alternative to surgery, particularly for IF tumors that are neither uncomfortable, painful, or disfiguring. == References ==