Flexor Hallucis Longus Tendon Pathology
- FHL tendonitis or injury, secondary to impingement, can occur at the posterior ankle or great toe, and is more common in patients undertaking excessive plantar-flexion activities (gymnasts).
- Patients typically complain of posteromedial ankle pain and crepitus or locking of the great toe.
- Examination may reveal pain of the hallux with resisted IPJ flexion, pain on passive ankle plantar flexion, triggering of the great toe.
- Diagnostics are not required for initial management or referral.
If an acute tendon rupture is suspected refer directly to A&E for specialist assessment. Initial conservative measures include;
- NSAIDs and simple analgesia
- OTC orthotics
- Activity modification – avoid exacerbating activities.
- Diagnostic uncertainty.
- Failure of conservative measures after a minimum of 3 months.
- Acute tendon rupture (refer to A&E).