Flexor Hallucis Longus Tenosynovitis 726.90

synonyms: FHL tendinitis, FHL tendinopathy

FHL Tenosynovitis ICD-9

• 726.90 Enthesopathy of unspecified site; capsulitis NOS; perarthritis NOS; tendinitis NOS
  

FHL Tenosynovitis Etiology / Epidemiology / Natural History

FHL Tenosynovitis Anatomy

• FHL anatomy

FHL Tenosynovitis Clinical Evaluation

• Rare condition usually in ballet dancersor patients exposed to repetitive trauma
• Poorly localized posterior ankle pain exacerbated by acute plantar flexion
• Pain in the posteromedial ankle when running , walking, or climbing stairs.
• Tenderness and swelling behind the medial malleolus.
• Pain, clicking or catching inthe posteromedial ankle with motion of the hallux
• Passive extension of the great toe is greater when the foot is plantarflexed.
• May have hallucis IP triggering
• Pain reproduced with active plantar flexion of the hallux against resistance.

FHL Tenosynovitis Xray / Diagnositc Tests

• A/P, Lateral and Mortiseankle xrays. Evaluate lateral xray for an fracture of the trigonal process or the presence of an os trigonum
• Consider dynamic views to demonstrate posterior impingement in maximal planter flexion.

FHL Tenosynovitis Classification / Treatment

• Activity modifications (no pointe for ballet dancers), NSAIDs, consider hard soled shoe for extreme cases.
• Consider surgical release of the FHL fibro-osseous tunnel if fails conservative treatment.

FHL Tenosynovitis Associated Injuries / Differential Diagnosis

• Achilles tendonitis
• Retrocalcaneal bursitis
• Flexor hallucis longus [FHL] tenosynovitis
• Haglund’s disease
• Osteochondritis dissecans
• Tarsal coalition
• Sural nerve entrapment
• Tarsal tunnel syndrome
• Popliteal artery entrapment

FHL Tenosynovitis Complications

FHL Tenosynovitis Follow-up Care

FHL Tenosynovitis Review References

• Hamilton WG, JBJS 1996;78:1491°