The flexor hallucis longus (FHL) musculotendinous junction is located in the posterior lower leg at the level of the ankle, where the FHL muscle belly transitions to tendon before passing through its fibro-osseous tunnel between the medial and lateral posterior talar tubercles. The tunnel is then passed deep to the flexor retinaculum and through Henry's node before inserting on the distal phalanx of the great toe. The musculotendinous junction level is a common site of FHL stenosing tenosynovitis.
FHL tenosynovitis at the musculotendinous junction and its fibro-osseous tunnel between the talar tubercles is the hallmark injury of ballet dancers, producing posterior ankle pain on demi-pointe and triggering of the great toe (trigger toe). The limited excursion of the muscle belly within the tunnel during ankle plantar flexion restricts great toe IP joint flexion simultaneously. Conservative treatment includes relative rest, physiotherapy, and corticosteroid injection. Surgical release of the fibro-osseous tunnel between the posterior talar tubercles through the posteromedial ankle approach is required for resistant cases.
The FHL musculotendinous junction impinges within the fibro-osseous tunnel between the medial and lateral posterior talar tubercles during repeated ankle plantar flexion in demi-pointe, producing posterior ankle pain and great toe triggering; ultrasound confirms tendon sheath thickening and surgical release of the fibro-osseous tunnel decompresses the tendon.
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