Flexor Hallucis Longus Tenosynovitis M77.9 726.90

 

synonyms: FHL tendinitis, FHL tendinopathy, flexor hallucis longus tendinosis, tendinopathy

FHL Tenosynovitis ICD-10

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 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

    FHL Tenosynovitis Complications

    FHL Tenosynovitis Follow-up Care

    FHL Tenosynovitis Review References

    • Hamilton WG, JBJS 1996;78:1491°