- PODIATRY -

Flexor Hallucis Longus (FHL) Tendinopathy

Common Symptoms

FHL tendinopathy symptoms include pain and swelling that may occur within the back of the ankle, under the arch and/or under the big toe. Pain generally presents over time and rarely occurs due to a traumatic event. Symptoms may become aggravated when performing movements that require you to rise onto your big toes such as, jumping, hopping, and running. Pain is worse with inactivity but once the body is mobilising and warmed up the pain may dissipate.

How it occurs

As seen in the image, the FHL muscle originates at the back (posterior) lower 2/3 of the fibula bone where it courses its way down past the inside of the ankle joint inserting onto the bottom of the big toe joint. The primary function of this muscle is to point the big toe. FHL tendinopathy predominantly occurs due to overuse triggering micro-trauma within the muscle although, other factors also play a role in its development such as:

-          Inappropriate and sudden increase of load throughout this muscle

-          Repetitive movement whereby the ankle and big toe joint are pointed

-          Foot rolls in excessively (pronation)

-          Excessive standing

-          Inappropriate footwear

What we may assess to obtain a diagnosis

Diagnosis is always subject to symptomatic complaint in conjunction with clinical testing performed by your podiatrist. FHL tendinopathy is commonly misdiagnosis as plantar fasciitis

and because of this specific clinical test including touching (palpation) of the painful area, joint range of motion and a comprehensive assessment of your walking or running (gait) is required.

At The Running Room and Posh Pod, we are equipped with a pressure plate treadmill (Zebris) allowing us to comprehensively assess plantar pressures within the feet. In more serve cases your podiatrist may send you for ultrasound or MRI imaging although, this is generally not necessary.

Management and how long does it take?

Management of FHL tendinopathy will primarily focus on tendon load through appropriate exercise prescriptions. In most cases it is imperative to not cease exercise but rather adapt movement patterns to appropriately manage the injury and your pain levels. Adjunct therapies which are used to assist in your recovery may include, dry needling, shock-wave therapy, footwear advice, soft-tissue massage, orthotic prescription and tapping techniques.

Author: Maddie Parker

Follow us on socials where we bring value to the run community.