Flexor Hallicus Longus Tendinopathy

Podiatrist Near MeThe Flexor Hallicus Longus

The flexor hallucis longus tendon originates from the calf muscle and courses along the instep of the ankle and foot, assisting with flexion of the big toe and maintenance of the medial longitudinal arch. This tendon can become irritated and inflamed due to a combination of its location and function as well as poor loading strategies or biomechanical deficits.


What is FHL tendinopathy

Flexor hallucis longus tendinopathy is caused by overuse of the flexor hallucis longus tendon. Repetitive use of the flexor hallucis longus muscle and, therefore, the flexor hallucis longus tendon can cause microscopic tears within the tendon. The failure to repair these microscopic tears within the tendon is termed tendinopathy.


Signs & Symptoms

  • Pain and swelling over the posterior part of the ankle
  • In some cases a clicking or grating sensation can be felt
  • Tenderness behind the inside ankle bone
  • Pain or weakness upon pushing your big toe down against resistance
  • Reduced range of movement

Can commonly be misdiagnosed as Achilles tendinopathy or posterior impingement due to the location of pain.


Risk Factors

This injury is common in runners and ballet dancers with repeated pushing off the foot & toes. This injury can be further worsened with everting or rolling out the foot, often in young dancers who have improper form when performing the ”turnout” manoeuvre.


Physiotherapy Management

  • RELATIVE rest from aggravating activities (complete rest is actually detrimental to tendon remodelling)
  • Physiotherapy modalities to manage pain and swelling (ice or heat, massage, dry needling)
  • Bracing or taping to unload the muscle & tendon
  • Heal raise inserts to offload the tendon
  • Assessment of running technique and implement strategies to improve Running Biomechanics
  • Structured Running or sport reloading program focusing on appropriate loading principles


Adjunctive Treatment Options 

  • Orthotics prescribed by our ModPod Podiatrists
  • Platelet-Rich-Plasma (PRP) Injection


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