FHL Tendinopathy


A 22 years old male professional ballet dancer with complaints of the left ankle. Dancing is not possible because of the posterior ankle pain and he describes locking complaints of the flexor hallucis longus (FHL). On investigation there is recognizable pain on palpation posteromedial with crepitus over the FHL. The posterior impingement test was positive. We performed a posterior ankle arthroscopy with reduction of the posterior talar process and FHL release. The FHL appeared to be badly damaged with longitudinal tearing and areas with neovascularization. The FHL itself was left untouched apart from radiofrequency debridement of the neovascularization.

Picture 2 (marker 1): FHL with multiple longitudinal tears.
Picture 2 (marker 2): Area with neovascularization.
Picture 2 (marker 3): Talus.
Picture 2 (marker 4): Subtalar joint.