FHL Tendinopathy


FHL tendinopathy is a condition that affects the flexor hallucis longus (FHL) tendon in the foot. FHL tendinopathy can cause significant pain and discomfort in the foot, often leading to difficulty walking or engaging in physical activity.

What is FHL Tendinopathy?

Flexor Hallucis Longus (FHL) tendinopathy is a condition that affects the FHL tendon, which runs along the back of the ankle and connects to the big toe. This tendon is responsible for flexing the big toe downwards, and it can become inflamed or damaged due to a variety of causes.

FHL Tendon Injury

FHL tendinopathy foot pain
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The FHL tendon can be injured in several ways. FHL tendonitis is a common condition that occurs when the tendon becomes inflamed due to overuse or strain. FHL tenosynovitis is another condition that affects the FHL tendon, causing inflammation of the synovial sheath that surrounds it. Other injuries that can affect the FHL tendon include tears and ruptures, resulting from sudden trauma or repeated strain over time.

Symptoms of FHL Tendinopathy

The symptoms can vary depending on the severity of the condition and the location of the damage. Common symptoms include pain, tenderness, and swelling in the foot and ankle, especially around the back of the ankle and the area around the big toe. Patients may also experience limited mobility and difficulty flexing the big toe downwards.

Treatment Options for FHL Tendinopathy

Several treatment options are available for FHL tendinopathy, depending on the severity of the condition. Non-surgical options include rest, ice, compression, and elevation, which can help reduce pain and inflammation in the affected area. Physical therapy and rehabilitation exercises are also effective treatment options, as they can help improve flexibility and strength in the foot and ankle. Surgery may sometimes be necessary to repair or replace the damaged FHL tendon.

If you suspect you may have FHL tendinopathy, seeking medical attention as soon as possible is important. Your doctor can evaluate your symptoms and recommend an appropriate course of treatment to help you manage your condition and achieve the best possible outcome.

Causes of FHL Tendinopathy

FHL tendinopathy can be caused by a variety of factors, including overuse injuries, trauma, and underlying medical conditions. Here are some common causes of FHL tendinopathy:

  • Overuse: FHL tendinopathy can develop from activities that require repetitive motions of the foot, such as running, jumping, or dancing. Overuse can cause the tendon to become irritated or inflamed, leading to pain and discomfort in the foot.
  • Trauma: FHL tendinopathy can also be caused by trauma, such as a sprain, strain, or other injury to the foot or ankle. Trauma can cause tears or ruptures in the FHL tendon, leading to pain, swelling, and other symptoms.
  • Medical conditions: FHL tendinopathy can be caused by underlying conditions such as arthritis or gout. These conditions can cause inflammation and swelling in the foot, which can lead to pain and discomfort in the FHL tendon.

Diagnosing FHL Tendinopathy

Diagnosing FHL tendinopathy often begins with a physical examination. Your doctor will ask you about your symptoms, when they first appeared, and whether anything makes them better or worse. During the exam, your doctor will look for signs of FHL tendinopathy, such as pain, tenderness, and swelling in the foot.

swelling of the feet can be one of the symptoms of FHL tendinopathy
Photo Credit: Drazen Zigic

If your doctor suspects that you have FHL tendinopathy, they may order imaging tests such as X-rays and MRIs to get a better look at the affected area. These tests can help confirm the diagnosis and rule out other possible causes of your symptoms.

Treating FHL Tendinopathy

Several treatment options are available for patients with FHL tendinopathy, ranging from non-surgical options to more invasive procedures. Here are some of the most common treatments:

Non-Surgical Options

Non-surgical options for treating FHL tendinopathy include rest, ice therapy, compression, elevation, and physical therapy. In some cases, pain relief medication or anti-inflammatory drugs may be prescribed. Massage therapy, stretching and strengthening exercises, and orthotic devices such as braces, supports, and shoe inserts can also benefit many patients.

Surgical Options

In some cases, surgery may be necessary to treat FHL tendinopathy. Arthroscopy, tenodesis, and tendon repair and graft procedures are all options that can be considered, depending on the severity of the condition and the patient’s overall health. Recovery time varies depending on the type of surgery performed, and patients may need to undergo physical therapy or other forms of rehabilitation in order to fully recover.

Orthotics and Footwear

Using orthotic devices such as braces, supports, and shoe inserts can be helpful for patients with FHL tendinopathy. These devices can provide support and stability to the foot, reducing the risk of further injury and allowing the foot to heal more quickly. Wearing properly fitted shoes with good arch support and cushioning can also be beneficial for many patients.

Activity Modification

Modifying your daily routine and avoiding activities that exacerbate your symptoms is important in managing FHL tendinopathy. This may involve taking a break from certain activities or reducing the intensity or duration of your workouts. Working with a physical therapist or other medical professional can help you develop an effective activity modification plan that will allow you to continue participating in the activities you love while promoting healing and reducing pain.

Conservative Care for FHL Tendinopathy

Treatment for FHL tendinopathy typically begins with conservative care options. This approach focuses on managing symptoms and promoting healing without surgical intervention.

Pain Relief

Pain relief medication can help with fhl tendinopathy
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To manage pain associated with FHL tendinopathy, over-the-counter pain relievers such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may provide relief. Consult with a healthcare professional before taking medications.

Physical Therapy

Physical therapy is an essential component of conservative treatment for FHL tendinopathy. Your physical therapist will work with you to develop a stretching and strengthening exercise program. This program will help reduce pain and inflammation and improve the flexibility and strength of the FHL tendon.

Activity Modification

Modifying daily activities to avoid those that cause pain or aggravate FHL tendinopathy symptoms can also help with recovery. Rest and avoid activities such as running, jumping or other high-impact exercises until symptoms subside.

Footwear and Orthotics

Your healthcare professional may recommend wearing a brace, support, or shoe insert to minimize pain and provide additional support for the foot. Proper footwear can also help provide stability and reduce the risk of reinjury.

It’s important to remember that FHL tendinopathy can take time to heal, and recovery time varies for each individual. Consistent treatment, care, and patience will help promote a full recovery.

Surgical Options for FHL Tendinopathy

If conservative treatment options are not successful, surgery may be necessary to repair or replace the damaged FHL tendon. There are several surgical options available, including:

  1. Arthroscopy: This minimally invasive procedure involves making small incisions in the foot and using a camera and small instruments to repair the FHL tendon.
  2. Tenodesis: This surgical procedure involves removing the damaged portion of the FHL tendon and reattaching the remaining healthy portion to another part of the foot.
  3. Tendon repair and graft: This procedure involves repairing the damaged FHL tendon or replacing it with a graft from another tendon.
  4. Tendon transfer: In some cases, the damaged FHL tendon may be replaced with a tendon from another part of the body.

Preventing FHL Tendinopathy

exercise and care measures can help with prevention of fhl tendinopathy
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While FHL tendinopathy can be a painful and debilitating condition, there are a number of steps that individuals can take to prevent it from occurring in the first place. By understanding the various risk factors and causes associated with FHL tendinopathy, individuals can make informed decisions and take proactive steps to protect their health and wellbeing.

FHL Anatomy

One of the key steps in preventing FHL tendinopathy is gaining a better understanding of the anatomy of the FHL tendon. Because this tendon is responsible for flexing the big toe and supporting the arch of the foot, it is particularly susceptible to overuse and injury. By learning more about how the FHL tendon functions and the various ways in which it can be injured, individuals can better protect themselves from these types of injuries.

Avoiding Risk Factors

Another important step in preventing FHL tendinopathy is avoiding the various risk factors associated with the condition. Some of the most common risk factors include participating in sports that require repetitive motions of the feet, and having an underlying medical condition such as arthritis. By paying close attention to these risk factors and avoiding or mitigating them, individuals can reduce their risk of developing FHL tendinopathy.

Maintaining Good Health and Fitness

Maintaining good overall health and fitness is also important in preventing FHL tendinopathy. By eating a healthy diet and exercising regularly, individuals can keep their muscles and tendons strong and flexible, reduce the risk of overuse injuries, and promote overall wellbeing. Additionally, individuals should be sure to wear appropriate footwear during sports and other activities, and take breaks as needed to rest and recharge.

Taking Action Early

Finally, it is important for individuals who experience symptoms of FHL tendinopathy to seek medical attention and explore their treatment options as soon as possible. By taking action early and getting the appropriate medical care, individuals can reduce the severity of their symptoms and increase their chances of a complete recovery.

Frequently Asked Questions about FHL TENDINOPATHY

What are the symptoms of FHL tendinopathy?

Symptoms of FHL tendinopathy include pain, swelling, and tenderness at the back of the ankle or lower leg. There may also be difficulty moving the big toe.

How do you treat flexor hallucis longus tendonitis?

Treatment for flexor hallucis longus tendonitis often involves rest, ice, compression, elevation (RICE), anti-inflammatory medications, physical therapy, and sometimes immobilization with a cast or boot.

How long does it take for flexor hallucis longus tendonitis to heal?

The healing time for flexor hallucis longus tendonitis varies depending on the severity of the injury and the chosen treatment. It may take a few weeks to several months for complete recovery.

What causes flexor hallucis longus tenosynovitis?

Flexor hallucis longus tenosynovitis is often caused by overuse, repetitive strain, or injury to the tendon that runs along the back of the ankle, leading to inflammation and irritation.