Flexor Hallucis Longus Tendon Pathology

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Patient Information

GP Information

Background Information

  • 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.

Investigation Guidelines

  • Diagnostics are not required for initial management or referral.

Management Recommendations

If an acute tendon rupture is suspected refer directly to A&E for specialist assessment. Initial conservative measures include;

  • PRICE
  • NSAIDs and simple analgesia
  • OTC orthotics
  • Activity modification – avoid exacerbating activities.
  • Physiotherapy

Referral Indications

  • Diagnostic uncertainty.
  • Failure of conservative measures after a minimum of 3 months.
  • Acute tendon rupture (refer to A&E).