The FHL tendon passes through the tarsal tunnel in its own sheath and then through a fibro-osseous tunnel beneath the sustentaculum tali where it can become stenotic, producing trigger toe from tendon catching at the talocrural fibro-osseous tunnel. This is the foot equivalent of trigger finger and is particularly common in ballet dancers who work on pointe for prolonged periods. The FHL also connects to the FDL at the knot of Henry in the plantar midfoot, where the two tendons cross.
Great toe flexion force transmission; ankle plantarflexion assistance; push-off propulsion
FHL tenosynovitis in ballet dancers produces posteromedial ankle pain reproduced by passive great toe dorsiflexion and resisted great toe plantarflexion. Hallux saltans (trigger toe) occurs when the thickened FHL tendon catches at the fibro-osseous tunnel at the posteromedial ankle, producing a palpable and sometimes audible click during great toe dorsiflexion. Surgical FHL tendon sheath release resolves trigger toe when conservative management fails.
Tendon sheath inflammation at the posteromedial ankle in dancers producing pain with great toe motion and resisted plantarflexion, managed with activity modification and occasionally sheath injection or release.
FHL tendon triggering at the fibro-osseous ankle tunnel producing a snapping toe sensation during movement, managed with surgical tendon sheath release for functional impairment.
