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Flexor hallucis longus dysfunction

L M Oloff1, S D Schulhofer

  • 1Sports Orthopedic and Athletic Rehabilitation Medicine Group (SOAR), Menlo Park, CA 94025, USA.

The Journal of Foot and Ankle Surgery : Official Publication of the American College of Foot and Ankle Surgeons
|May 8, 1998
PubMed
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Flexor hallucis longus stenosing tenosynovitis, often misdiagnosed, requires surgical tenolysis for successful treatment. This condition, affecting various patient groups, showed a 100% success rate with prompt recovery.

Area of Science:

  • Orthopedic Surgery
  • Sports Medicine
  • Podiatry

Background:

  • Flexor hallucis longus (FHL) tenosynovitis is classically associated with athletic activities like ballet.
  • This condition is frequently misdiagnosed, leading to delayed treatment and prolonged symptoms.
  • Patients often present with overlapping symptoms mimicking other foot and ankle pathologies.

Purpose of the Study:

  • To evaluate the efficacy of operative tenolysis for FHL stenosing tenosynovitis.
  • To identify diagnostic challenges and clinical indicators for FHL tenosynovitis.
  • To determine the recovery timeline following surgical intervention.

Main Methods:

  • Retrospective review of 19 consecutive cases undergoing FHL tenolysis.
  • Analysis of patient demographics, symptom duration, and prior medical encounters.

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  • Correlation of clinical signs (posteromedial ankle pain, medial arch pain, positive Tinel's sign) with diagnosis.
  • Utilized magnetic resonance imaging (MRI) and tenography for diagnosis.

    • Main Results:

    • The study population was primarily nonathletic, middle-aged males, contrary to classical descriptions.
    • Mean symptom duration was 20 months, with common misdiagnoses.
    • 14 (74%) patients had two of three key clinical signs; 6 (32%) had all three.
    • Operative tenolysis was 100% successful, with a mean return to activity at 9 weeks.

    Conclusions:

    • FHL stenosing tenosynovitis may be underdiagnosed and occurs in diverse patient populations.
    • Clinical presentation can overlap with tendinitis, plantar fasciitis, and tarsal tunnel syndrome.
    • Surgical tenolysis is a highly effective treatment for FHL stenosing tenosynovitis, with rapid functional recovery.