Flexor Hallucis Longus Tendonitis Symptoms & Treatment

Tendons are strong, fibrous cords that connect muscles with bones. The flexor hallucis longus (FHL) tendon extends from the calf muscle, past the side of the ankle, and all the way to the big toe. This tendon helps you flex your big toe and stand on the tips of your toes. Overuse of this tendon can cause inflammation, called tendonitis, also referred to as flexor hallucis longus tendonitis or FHL tendon inflammation.

FHL tendonitis is relatively uncommon. However, dancers and other active people who do a lot of pushing off are at greater risk for this injury, a condition sometimes nicknamed dancer’s tendonitis due to its prevalence among ballet dancers.

A common cause of flexor hallucis longus tendonitis is repeated pushing off from the big toe, a movement common among ballet dancers and other athletes. Over time, this motion can irritate the tendon, causing it to become inflamed and lead to big toe tendon pain or even foot arch strain.

FHL tendonitis is most common in these sports:

• Dancing
• Gymnastics

Symptoms of FHL tendonitis usually include pain, especially on the inside of the ankle bone. Pain often develops very slowly over time rather than due to a single event. Other common symptoms include:

• Swelling of the ankle
• Pain that is worse when pushing off your toes
• A clicking sensation in the ankle, especially when flexing the toe

If you have nagging big toe tendon pain or discomfort around your toe or ankle area, you should consult with your doctor. At your visit, your doctor will conduct a physical examination, looking for signs of tenderness around your ankle. Your doctor may also try to recreate the symptoms you experience when active by bending your toe and having you flex it with resistance against it. X-rays may also be taken to rule out other causes of your injury, such as bone spurs or a fracture. Sometimes, other imaging tests, such as magnetic resonance imaging (MRI), may be ordered to confirm the diagnosis of flexor hallucis longus tendonitis.

Treatment of FHL tendonitis is usually conservative. Your doctor may advise you to take time off from dancing or other physical activities that cause FHL tendon inflammation or foot arch strain. Other common treatments include:

• Applying ice and elevating your foot to reduce swelling and pain
• Wearing a cast or special boot to support your foot
• Anti-inflammatory medication for pain relief
• Physical therapy to strengthen the FHL tendon

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

flexor hallicus longus tendonitis

Surgery is generally not needed to treat flexor hallucis longus tendonitis. In rare cases, surgery may be considered if your symptoms don’t improve with rest and other conservative treatments. Your doctor will advise if you should explore surgery as a treatment option.

In most cases, normal activity can resume within a few weeks with rest and conservative treatment of FHL tendonitis. When surgery is involved, recovery time will take up to three months before you can return to play.