What?

Flexor Hallucis Longus muscle (and subsequent tendon) runs down the medial border of the tibia past the malleolus and inserts into the plantar surface of the foot and into the base of distal phalanx of hallux. Its role is to move the big toe downwards. FHL pain is usually characterised by medial ankle and foot pain. Sometimes, the discomfort can run up into the medial calf.

How?

Tendon pain can occur due to an overload or an acute injury causing a tear. Typical activities of overload include running and jumping. It can be irritated in end of range plantarflexion eg calf raise or in a stretch position e.g. knee’s over toes with heel down.

When?

Not necessarily typical of a certain age group. Can commonly be seen in dancers (who spend a lot of time in the aggravating positions mentioned above). Can also be seen in those with calf insufficiencies, either transient or permanent e.g. post-surgery like an Achilles repair or after a traumatic injury like an ankle sprain

How does it resolve?

· Avoiding aggravating positions/activities until it settles

· Progressively building load capacity

What is the treatment?

The focus of treatment is to reduce pain levels and restore the capacity of the tendon. This can be done in a few different ways including:

- Manual therapy (eg muscle massage)

- Taping to offload the tendon

- Exercises to strengthen key areas eg calf

- Implementation of load management strategies (eg mapping out impact activities)

- Voltaren gel wrap at night time

If you would like your injury reviewed by one of our physiotherapists, then don’t hesitate to book an appointment.