The hallucis longus tendon, also known as the flexor hallucis longus (FHL) tendon, plays a role in big toe movement. This strong, cord-like structure is involved in fundamental actions like walking, standing, and maintaining balance. Understanding this tendon highlights its importance for everyday mobility.
Anatomy and Function of the Hallucis Longus
The hallucis longus tendon originates from a muscle in the lower two-thirds of the back of the fibula, one of the two lower leg bones. From there, it travels downwards, passing behind the ankle joint, specifically behind the medial malleolus, the bony bump on the inside of your ankle. It then courses along the sole of the foot, running through a fibrous tunnel and inserting into the base of the big toe’s end bone.
The primary function of this tendon is to flex the big toe, bending it downwards towards the sole of the foot. This action is important during the “push-off” phase of walking, running, and jumping, helping propel the body forward. It also contributes to stabilizing the foot and maintaining the arch during movement.
Common Injuries and Conditions
The hallucis longus tendon is susceptible to issues, primarily from repetitive stress or overuse. Two common conditions are tendinitis and tenosynovitis. Tendinitis refers to damage or degeneration of the tendon’s collagen fibers, often involving tiny tears from overuse. Tenosynovitis is inflammation of the synovial sheath that surrounds the tendon, a tube-like structure that helps it glide smoothly. These two conditions frequently occur together.
Activities requiring continuous big toe flexion or push-off motions are common causes. Ballet dancers are particularly susceptible, leading to the nickname “dancer’s tendinitis,” as their movements like “en pointe” or “relevé” involve extreme plantarflexion and compression. Runners, hikers, and athletes in sports with quick starts and stops also face risk.
Symptoms often include pain and aching deep in the back of the ankle, along the arch of the foot, or under the big toe. Swelling in the ankle, stiffness in the big toe, and a clicking or locking sensation when moving the toe can also be present.
Treatment and Recovery
Initial management of hallucis longus tendon issues often involves conservative approaches to reduce pain and inflammation. Rest from aggravating activities is recommended, along with ice application, compression, and elevation of the affected foot. Activity modification is also recommended to reduce strain on the tendon.
Physical therapy aids recovery, aiming to restore strength, flexibility, and proper foot mechanics. This includes specific stretching exercises for the calf and ankle, along with strengthening routines for the hallucis longus and surrounding muscles to improve stability. A physical therapist may guide exercises like towel curls with the big toe or heel raises, progressing to more dynamic movements as symptoms improve.
In some cases, anti-inflammatory medications may be considered to manage pain and swelling. If conservative methods are not effective, a doctor might explore other treatments, such as corticosteroid injections into the tendon sheath to reduce inflammation. Surgical intervention is considered only when other treatments have not provided relief. Recovery times vary, ranging from a few weeks for mild cases to several months for more severe or chronic issues.