A small bursa is located at the level of the posterior ankle between the flexor hallucis longus tendon and the posterior talus or os trigonum as the tendon passes through its fibro-osseous groove. It cushions the tendon as it changes direction around the sustentaculum tali to reach the hallux. This bursa is closely related to the posterior ankle joint recess.
Flexor hallucis longus bursitis occurs in ballet dancers and others who perform repetitive forced plantarflexion, particularly in the en pointe position. The bursa can communicate with the ankle joint, explaining why FHL-related symptoms may coexist with posterior ankle impingement. Ultrasound and MRI demonstrate fluid around the FHL tendon in the posterior ankle groove. Posterior ankle arthroscopy allows simultaneous FHL tendon release and bursal excision.
Bursal and tenosynovial inflammation around the FHL in the posterior ankle groove, producing posterior ankle pain during plantarflexion in dancers and athletes, managed with activity modification, physiotherapy, and posterior ankle arthroscopy for refractory cases.
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