Condition Articles-Flexor Hallucis Longus Tendinosis PDF

Flexor Hallucis Longus Tendinosis PDF

Pdf Summary

Flexor Hallucis Longus (FHL) Tendinosis is a condition that causes pain in the posteromedial ankle. It is more common in individuals who engage in repetitive forefoot push-off and extreme plantar flexion, such as ballet dancers. The FHL is a muscle that originates from the fibula and interosseous membrane and inserts on the plantar surface of the distal phalanx of the great toe. It functions to plantar flex the great toe and aids in plantar flexion and supination at the ankle and subtalar joint.<br /><br />The cause of FHL tendinosis is debated, but many believe that constriction through the fibro-osseus tunnel induces the injury. This leads to irritation, swelling, and scarring of the tendon, causing increased binding. Symptoms of FHL tendinosis include insidious onset of pain at the posterior or posterior-medial ankle, which worsens with activity, especially great toe push off.<br /><br />Diagnosis involves evaluating pain and swelling along the course of the FHL and testing FHL excursion at the ankle, knot of Henry, and sesamoids. Imaging, such as weight bearing radiographs and MRI, may be helpful in assessing the severity of the tendinosis and looking for ankle split tears.<br /><br />Non-operative treatment involves rest, activity modification, and NSAIDs for pain. Boot brace immobilization may also be beneficial. If symptoms persist, surgical intervention can be considered, but only after 6 months of non-operative treatment. Surgical interventions include releasing the fibro-osseous sheath, repairing FHL tears, and/or excising an os trigonum. Arthroscopic release is an option, but caution is advised due to the proximity of the neurovascular bundle.<br /><br />In conclusion, FHL tendinosis is a rare condition that should be considered, especially in populations that engage in repetitive forefoot push-off and extreme plantar flexion. Non-operative treatment is the first line of treatment, and surgical intervention should only be considered if symptoms do not improve after 6 months. Realistic expectations should be discussed with patients prior to any surgical intervention.

Keywords

Flexor Hallucis Longus Tendinosis

posteromedial ankle pain

repetitive forefoot push-off

extreme plantar flexion

ballet dancers

fibro-osseous tunnel

FHL excursion

weight bearing radiographs

MRI

non-operative treatment