Posterior Ankle Impingement and Flexor Hallucis Longus Pathology

Sharpe, B. Dale; Steginsky, Brian; Suhling, Mallory; Vora, Anand

doi:10.1016/j.csm.2020.06.001

Cited by 10 publications

(16 citation statements)

References 55 publications

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“…This generally causes pain at the entrapment area or the first metatarsophalangeal joint [9,19]. This injury is frequently seen in runners, tennis players, and dancers, who require dynamic, repetitive, or push-off movement [19,27].…”

Section: Discussionmentioning

confidence: 99%

Type and location of flexor hallucis longus musculotendinous junctions and its tendinous interconnections with flexor digitorum longus tendon: pertinent data for tendon harvesting and transfer

Wan-ae-loh¹,

Huanmanop²,

Agthong³

et al. 2022

Folia Morphol

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Background: Anatomy of flexor hallucis longus (FHL) is essential for the achievement of tendon transfer and several procedures performed in the foot and ankle. The aim of this study was to evaluate the anatomical knowledge of FHL including the type and location of musculotendinous junction (MTJ), tendinous interconnections (TIC) morphology, its location related to Master Knot of Henry (MKH), and the pattern of TIC distribution. Materials and methods: One hundred and sixty-six legs from 52 embalmed and 31 soft cadavers were assessed. The medial and lateral bellies of FHL (MB and LB) were identified and traced until the end of the most distal muscle fiber to determine the medial and lateral MTJs. MTJ was classified into 4 types based on the existence and length of MB and LB: Type 1, long LB and shorter MB; Type 2, equal length of both bellies; Type 3, only LB and no MB; Type 4, long MB and shorter LB. Low lying muscle belly was defined as muscle extending beyond the zero point (the point of intersection between distal osseous part of tibia and FHL tendon). The distance between MTJ and zero point was measured. TIC was classified into seven types based on the direction and number of slip: Type I, one slip from

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Section: Discussionmentioning

confidence: 99%

Type and location of flexor hallucis longus musculotendinous junctions and its tendinous interconnections with flexor digitorum longus tendon: pertinent data for tendon harvesting and transfer

Wan-ae-loh¹,

Huanmanop²,

Agthong³

et al. 2022

Folia Morphol

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“…The diagnosis of FHL tendonitis is primarily clinical, with imaging playing an ancillary or confirmatory role. The existence of FHL tendonitis can be demonstrated by the presence of tenderness elicited along the flexor hallucis longus at the proximal entrance of the fibroosseous tunnel in the posterior medial ankle [11, 16, 19], underneath the sustentaculum talus, and at the knot of Henry (Fig. 2) [11, 16, 19].…”

Section: Methodsmentioning

confidence: 99%

“…The existence of FHL tendonitis can be demonstrated by the presence of tenderness elicited along the flexor hallucis longus at the proximal entrance of the fibroosseous tunnel in the posterior medial ankle [11, 16, 19], underneath the sustentaculum talus, and at the knot of Henry (Fig. 2) [11, 16, 19]. There may also be pain produced in the dorsal first metatarsophalangeal (MTP) joint with hallux dorsiflexion [5].…”

Section: Methodsmentioning

confidence: 99%

What Is the Efficacy of a Nonoperative Program Including a Specific Stretching Protocol for Flexor Hallucis Longus Tendonitis?

Michelson

Bernknopf

Charlson

et al. 2021

Clin Orthop Relat Res

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Background Diagnosis and treatment of tendonitis/entrapment of the flexor hallucis longus (FHL) has been sporadically described in the evidence, primarily in the context of dancers and other athletes. Although various nonspecific nonoperative treatments have been described, it is not clear how often they achieve a satisfactory amount of symptom improvement. Questions/purposes The present study was designed to address the following questions regarding the nonoperative treatment of FHL tendonitis: (1) In a population of patients where the default management option for FHL tendonitis is a comprehensive nonsurgical approach, what proportion of patients thus treated opted not to have surgery? (2) What factors were associated with a patient’s decision to undergo surgery after a period of nonsurgical management? Methods The 656 patients included were all those diagnosed with FHL tendonitis who were initially treated nonoperatively in the foot and ankle division between January 2009 and December 2018. Demographics, comorbidities, examination findings, imaging results, pain scores, treatment instituted, and final outcome were obtained from the electronic medical record. The primary outcome was the decision to have surgery due to unsatisfactory symptom improvement. We compared patients who opted for surgery with those who did not after nonoperative treatment with univariable and multivariable statistics using demographics, comorbidities, and clinical findings as potential risk factors, with p < 0.05. Results Forty-four percent (180 of 409) of patients decided to forgo surgery after the institution of a specific FHL stretching program. Surgery was more likely in patients with clinical hallux rigidus (OR 2.4 [95% CI 1.16 to 4.97]; p = 0.02) or posteromedial ankle pain (OR 1.78 [95% CI 1.12 to 2.83]; p = 0.01) and less likely in those who completed an FHL stretching program (OR 0.15 [95% CI 0.08 to 0.27]; p < 0.001). Conclusion FHL tendonitis is more common than the previous evidence suggests and frequently occurs in nonathletes. Once it was diagnosed by detection of tenderness anywhere along the tendon, most frequently at the fibroosseous tunnel, nonoperative treatment focused on specific FHL stretching and immobilization in more severe cases reduced the symptoms to the extent that 44% of patients decided that surgery was unnecessary. The key to its diagnosis is awareness that this injury is possible because most patients treated in this study had been previously seen by orthopaedic providers who had not appreciated the presence of the condition, leading to a delay in diagnosis and treatment of more than a year in many patients. Level of Evidence Level III, therapeutic study.

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“…1 8 9 Among the affected anatomical structures, the flexor hallucis longus (FHL) is involved in more than two-thirds of the cases. [10][11][12] The origin of anatomical variations, such as the OT and SP, is at the posterior talar nucleus ossification phase between 8 and 11 years of age. 13 14 Histologically, OT represents an accessory ossicle partially united through a fibrous or cartilaginous bridge to the posterior talus and is present in 5%-15% of normal feet.…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic os trigonum en-bloc removal outcomes at 6-month follow-up are better compared to Stieda’s process resection in patients with posterior ankle impingement syndrome: a prospective comparative study

Symeonidis¹,

Papakostas

Fermín³

et al. 2021

Journal of ISAKOS

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Posterior Ankle Impingement and Flexor Hallucis Longus Pathology

Cited by 10 publications

References 55 publications

Type and location of flexor hallucis longus musculotendinous junctions and its tendinous interconnections with flexor digitorum longus tendon: pertinent data for tendon harvesting and transfer

Type and location of flexor hallucis longus musculotendinous junctions and its tendinous interconnections with flexor digitorum longus tendon: pertinent data for tendon harvesting and transfer

What Is the Efficacy of a Nonoperative Program Including a Specific Stretching Protocol for Flexor Hallucis Longus Tendonitis?

Arthroscopic os trigonum en-bloc removal outcomes at 6-month follow-up are better compared to Stieda’s process resection in patients with posterior ankle impingement syndrome: a prospective comparative study

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