FHL tenosynovitis—often referred to as “dancer’s tendonitis”—is a condition characterized by inflammation of the flexor hallucis longus tendon and its synovial sheath, typically affecting individuals engaged in repetitive ankle bending actions like forefoot push-off and extreme plantarflexion activities such as ballet, gymnastics, running, and swimming.
The FHL muscle originates from the posterior fibula, runs behind the ankle joint, and then inserts at the base of your big toe. It plays a vital role in plantarflexion of the big toe and contributes to ankle stability during gait and propulsion.
Symptoms commonly include ankle pain on the inside of the ankle joint, grating and grinding sounds that occur at the same time as pain, and triggering or locking of the big toe during motion. Pain may also radiate to the midfoot or along the inside of your forefoot, mimicking other conditions such as posterior impingement syndrome, tarsal tunnel syndrome, sesamoiditis, or plantar fasciitis. Accurate diagnosis is essential and involves clinical examination—such as palpation along the tendon course and the FHL stretch test—as well as imaging modalities like MRI or ultrasound to confirm tenosynovitis and rule out differential diagnoses.
Physiotherapy plays a central role in assessment, diagnosis and conservative management, particularly in early-stage cases. Physiotherapy typically includes planning an individualised approach to activity modification (perhaps less ankle bending), looking at the role of some NSAIDs medications, and pivotal targeted rehabilitation exercises such as FHL stretching and strengthening to restore tendon mobility and reduce inflammation. Immobilization using walking boots or night splints may be employed for symptom control. A progressive return to loading strategy (AKA a plan to get back to all the fun things) is a constant theme of your consultations, tracking according to the capacity of your tendon and your tolerance to coping with calf raise, hopping, changes directions and running once more. Its not just ‘return to life’ once a certain amount of time has elapsed, let’s resolve this injury successfully!
Given the anatomical complexity and potential for misdiagnosis, a thorough assessment by your OHL physiotherapist is crucial. If you suspect FHL tenosynovitis, early intervention can prevent chronic dysfunction and facilitate a safe return to activity. Contact us at 9431 5955 or book online via the Client Portal to begin your recovery journey.
