Flexor Hallucis Longus (FHL) Tendinopathy

What is it?

 Flexor Hallucis Longus (FHL) is a muscle in your lower leg that is primarily focused on flexing the big toe and plantar flexing the ankle (points toes to ground) while walking/running. The muscle belly is in the deep compartments of your leg and its tendon runs past your inside ankle bone and inserts onto the base of the big toe. Occasionally, this muscle/tendon can be over-worked and begins to degenerate. This is known as Flexor Hallucis Tendinopathy (degeneration). Clinical features of the conditions are medial (inside) ankle pain, pain while standing on toes and pain with flexion of the big toe.

Risk factors:

• Over-use (especially ballet dancers)

• Toe-griping

• Poor footwear

• Poor biomechanics

• Direct trauma

• Sudden increase in activity

Symptoms:

• Gradual build-up of soreness and stiffness.

• Reduced function of the big toe joint.

• Big toe joint weakness and pushing down.

• Walking difficulty.

• Swelling and inflammation throughout the foot and back the ankle.

How is it diagnosed?

A thorough history/clinical examination will generally be sufficient to correctly diagnose FHL tendinopathy. An Ultrasound or MRI may be requested to confirm the diagnosis or to rule out further pathology.

Treatment Options:

• Rest, ice, compression

• Modified activities/levels.

• Stretching/strengthening

• Soft tissue therapy

• Custom orthotics

• Footwear advice

• Dry needling

• Surgery

Prognosis:

Providing complete compliance on the patient’s behalf, resolution is often achieved with the conservative treatments listed above. Surgery is rarely recommended and is the last resort for chronic/non-responsive cases.