Hello, I'm going to talk about this case report named idiopathic haluxaltans, an unusual presentation of flexoral luteus longus tendinopathy. I have no disclosures. The haluxaltan is a rare condition characterized by an entrapment of the FHL tendon in his pathway through the intercollicular fibrosus tunnel of the talus. This is mainly caused by a tendon thickening before entering the distal part of its sheath. This is related to sports that require excessive plantar flexion, such as classic ballet dancers, soccer players, or downhill runners among others. Typical locations are the retromedular FHL sheath, this is the most frequent location, could be within the fibrosus tunnel below the sustentaculum talus, at Henry Masternod or behind the interseximal ligament at the MTP joint. Despite it is recognized as an idiopathic condition, it is related to some space-occupying spaces, such as ostrigonum, steta process, cystic formation, accessory flexor digitorum longus, calcaneal fracture, ankylartrodesis, or tumors such as lipopentramatosis or lipomatosis. Symptoms are very similar to its analogue in the hand, with preserved flexion movement with the sudden release during extension, this is called the trigger effect. This is a 23-year-old male patient that came to visit us at our office with no history of previous trauma or known painful condition, but his main concern was about a painless audible snapping of the hallux during active extension. The diagnosis was made with the aforementioned symptoms and confirmed by an MRI, where informed a significant fusiform thickening of the FHL at the posterior margin of the talus, with a slight thickening of the synovial sheath as we see in these MRI slides with a white arrow. We first intended to do a conservative treatment with physiotherapy, sports rest for 21 days, NSAIDs, eyes, and corticosteroid infiltration with no success, so at three months we had to make a posterior ankylartroscopy. We did a partial resection of the fibro-oseus tunnel and tendon thinning by resecting the excessive scar tissue as we see in these images. Then after this stenosynovectomy and release, the ankyl and hallux were mobilized directly visualizing its free movement through the tunnel. Then at the post-op we allowed the partial weight bearing assisted by two crunches for one week and then after removing stitches as two weeks he started with a supervisory physiotherapy program working on active and passive range of motion. We didn't have any complication or other adverse outcome. At six months follow-up the patient presented with no tenderness along the FHL or any snapping sensation. So as we mentioned before this is an unusual presentation, extreme presentation of FHL tenosynovitis where conservative treatment are reported to have a 46 to 64 success and if this fails surgical treatment is warranted where 80 to 90 percent success have been reported after either open or arthroscopic FHL release. Despite the good result with the open release we prefer arthroscopy for better visualization and less soft tissue damage. We are out to resecting up to 50 percent of the tendon if considered necessary.

idiopathic haluxaltans

entrapment of FHL tendon

thickening of tendon

snapping sensation

surgical treatment