The flexor hallucis longus tendon runs in its own fibro-osseous tunnel in the groove between the medial and lateral tubercles of the posterior talus, the most posterior structure of the tarsal tunnel, then passes under the sustentaculum tali. In the sole it crosses the FDL at the master knot of Henry and runs between the hallux sesamoids to its distal phalanx insertion. It is the principal power tendon of the great toe and a critical component of the toe-off mechanism, and its posterior ankle tunnel is a common site of tenosynovitis in ballet dancers.
| Muscle | |
|---|---|
| Attachment | Distal phalanx of the great toe (plantar surface) |
Great toe push-off power; medial longitudinal arch support during propulsion
FHL tenosynovitis (dancer's tendinitis) produces posteromedial ankle pain with great toe movement, classic in ballet dancers who work in extreme plantarflexion (en pointe, demi-pointe) that repeatedly compresses the tendon in its tunnel behind the talus. A low-lying muscle belly or nodule may catch at the tunnel entrance, producing a trigger or clicking great toe. Passive great toe dorsiflexion reproduces the pain, and the condition often coexists with posterior ankle impingement from an os trigonum. Injection into the sheath can confirm the diagnosis, and open or endoscopic release of the fibro-osseous tunnel is performed for refractory cases.
Inflammation within the FHL fibro-osseous tunnel producing posteromedial ankle pain with great toe movement, classic in ballet dancers and reproduced by the FHL stretch test of passive great toe dorsiflexion.
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