The FHL tendon passes in its own fibro-osseous tunnel behind the medial malleolus and under the sustentaculum tali — the most posterior and largest structure in the tarsal tunnel. FHL tenosynovitis at the ankle level produces medial ankle and posteromedial heel pain in dancers (known as dancer's tendinitis) from repetitive plantarflexion loading at the medial malleolus level. Triggering FHL (stenosing tenosynovitis) produces a trigger toe or trigger hallux.
Great toe plantarflexion via the FHL tunnel behind the medial malleolus and under the sustentaculum tali
FHL tenosynovitis in ballet dancers produces posteromedial ankle pain during pointe and releve positions. The passive great toe extension test (dorsiflexing the hallux while the ankle is plantarflexed) reproduces the pain by stressing the FHL within its tunnel. Injection into the FHL sheath provides diagnostic confirmation. Endoscopic FHL release at the fibro-osseous tunnel resolves stenosing tenosynovitis.
FHL tenosynovitis at the medial malleolus tunnel from ballet pointe positions producing posteromedial ankle pain managed with injection and endoscopic sheath release.
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