Posterior Ankle Arthroscopy for Flexor Hallucis Longus Entrapment: A Case Report

Introduction: Stenosing tenosynovitis is a chronic disorder frequently observed in finger triggering of a digit. Regarding the toes, although entrapment of the flexor hallucis longus (FHL) has already been reported in a few cases among sports players, the clinical condition is uncommon. Besides, the case without any specific causes is particularly rare. Case Report: We report the case of a 26-year-old male with FHL entrapment. Even though he was unaware of any cause, he felt tenderness on the posteromedial side of his left ankle, and his great toe was locked in the flex position. Magnetic resonance imaging indicated effusion in the tendon sheath of the FHL and the possibility of a partial tear of the FHL. We hypothesized that the scar tissue secondary to the partial tear of the FHL may have been irritated at the retrotalar pulley below the sustentaculum tali, where the FHL glides. Therefore, posterior ankle arthroscopy was performed for the treatment of the FHL entrapment. Conclusion: Orthopedic surgeons should list this pathology as a differential diagnosis of posterior ankle pain, even in non-athletes.

[1]  U. Kanatlı,et al.  Endoscopic treatment of bilateral hallux saltans in an ordinary woman. , 2019, Eklem hastaliklari ve cerrahisi = Joint diseases & related surgery.

[2]  M. Torriani,et al.  Hallux saltans due to stenosing tenosynovitis of flexor hallucis longus: dynamic sonography and arthroscopic findings , 2018, Skeletal Radiology.

[3]  Song Ho Chang,et al.  Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon Associated with the Plantar Capsular Accessory Ossicle at the Interphalangeal Joint of the Great Toe , 2017, Case Reports in Orthopedics.

[4]  Hiroteru Hayashi,et al.  Arthroscopic Release of Flexor Hallucis Longus Tendon Sheath in Female Ballet Dancers: Dynamic Pathology, Surgical Technique, and Return to Dancing Performance. , 2015, Arthroscopy techniques.

[5]  Julie E. Adams,et al.  Tendinopathies of the Hand and Wrist , 2015, The Journal of the American Academy of Orthopaedic Surgeons.

[6]  R. Karuppal,et al.  Hallux saltans due to flexor hallucis longus entrapment at a previously unreported site in an unskilled manual laborer: a case report. , 2012, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[7]  J. Vallotton,et al.  Functional hallux limitus or rigidus caused by a tenodesis effect at the retrotalar pulley: description of the functional stretch test and the simple hoover cord maneuver that releases this tenodesis. , 2010, Journal of the American Podiatric Medical Association.

[8]  Paul S. Shurnas,et al.  Hallux rigidus: etiology, biomechanics, and nonoperative treatment. , 2009, Foot and ankle clinics.

[9]  W. Hamilton.  Posterior ankle pain in dancers. , 2008, Clinics in sports medicine.

[10]  Feyyaz Çiftçi,et al.  A previously unreported etiology of trigger toe. , 2006, Journal of the American Podiatric Medical Association.

[11]  P. Lereim.  Trigger toe in classical-ballet dancers , 2004, Archives of Orthopaedic and Trauma Surgery.

[12]  T. Pufe,et al.  Blood Supply of the Flexor Hallucis Longus Tendon with Regard to Dancer's Tendinitis: Injection and Immunohistochemical Studies of Cadaver Tendons , 2003, Foot & ankle international.

[13]  J. Grady,et al.  A retrospective analysis of 772 patients with hallux limitus. , 2002, Journal of the American Podiatric Medical Association.

[14]  P. Wolin,et al.  Os trigonum syndrome with flexor hallucis longus tenosynovitis in a professional football referee. , 1999, Medicine and science in sports and exercise.

[15]  Peter M. Boruta,et al.  Partial Tear of the Flexor Hallucis Longus at the Knot of Henry: Presentation of Three Cases , 1997, Foot & ankle international.

[16]  L. Micheli,et al.  Tenosynovitis of the flexor hallucis longus in a long-distance runner. , 1996, Medicine & Science in Sports & Exercise.

[17]  W. Hamilton.  Differential diagnosis and treatment of posterior ankle pain in dancers and equinus athletes. , 1995, Journal of back and musculoskeletal rehabilitation.

[18]  W. Hamilton,et al.  So-called trigger ankle due to an aberrant flexor hallucis longus muscle in a tennis player. A case report. , 1992, Journal of Bone and Joint Surgery. American volume.

[19]  W. Hamilton.  Foot and ankle injuries in dancers. , 1988, Clinics in sports medicine.