FHL is the most powerful toe flexor, contributing approximately 20% of total ankle plantarflexion force. Its tendon passes through the fibro-osseous tarsal tunnel behind the medial malleolus.
| Origin | Posterior fibular shaft — lower two-thirds |
|---|---|
| Insertion | Base of the distal phalanx of the hallux |
| Nerve Supply | Tibial nerve (S2, S3) |
| Blood Supply | Peroneal artery |
| Actions | Flexes the hallux IP joint — primary action; Plantarflexes the ankle; Supports the medial longitudinal arch |
|---|
FHL tendinopathy produces posteromedial ankle pain in ballet dancers (posterior ankle impingement). FHL is the premier tendon transfer for Achilles reconstruction. FHL nodule causes trigger hallux.
Palpated posterior to the medial malleolus during resisted hallux IP flexion.
Stenosing tenosynovitis in the posterior ankle tunnel producing posteromedial pain and triggering hallux, managed by sheath release.
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