Flexor hallucis longus tendinopathy is a prevalent and debilitating condition among dancers and runners, significantly affecting their performance and quality of life. Understanding its manifestation as “dancer’s tendonitis,” recognizing posterior ankle impingement signs, implementing eccentric strengthening protocols, exploring ultrasound – guided injection techniques, and evaluating surgical release outcomes are essential for effective management.
“Dancer’s Tendonitis” Presentation
Often referred to as “dancer’s tendonitis,” flexor hallucis longus tendinopathy presents with distinct symptoms that are closely tied to the repetitive movements and demands of dancing and running. The primary symptom is pain, typically located in the posterior aspect of the ankle, near the inside of the heel. This pain can range from a mild ache to a sharp, stabbing sensation and often worsens with activities that involve excessive use of the tendon, such as pointed foot positions in dance or the push – off phase during running.
Dancers may notice pain when performing movements like relevés, where they rise up onto the balls of their feet, or during jumps and landings. Runners, on the other hand, may experience pain during the toe – off portion of their stride, as the flexor hallucis longus tendon helps to flex the big toe and push the body forward. Along with pain, swelling and tenderness around the tendon can also occur. In more chronic cases, dancers and runners might feel a catching or popping sensation in the ankle, and there may be a loss of strength and range of motion in the big toe, making it difficult to perform normal dance steps or maintain a proper running gait.
Posterior Ankle Impingement Signs
Posterior ankle impingement often coexists with flexor hallucis longus tendinopathy and presents with its own set of characteristic signs. Patients may experience pain deep in the back of the ankle, which is typically exacerbated by movements that force the ankle into extreme plantar flexion, such as in deep plie positions for dancers or downhill running for runners. This pain can be accompanied by a feeling of stiffness and a reduced ability to move the ankle freely.
There may also be swelling around the posterior ankle joint, and in some cases, a palpable mass or thickening of the tissues can be detected. Additionally, dancers and runners may notice a decrease in their performance, as the pain and discomfort limit their ability to execute movements with precision and power. Numbness or tingling in the foot, particularly in the area served by the nerves that run near the impinged region, may also occur in more severe cases.
Eccentric Strengthening Protocols
Eccentric strengthening exercises are a cornerstone of the rehabilitation for flexor hallucis longus tendinopathy. These exercises focus on the lengthening phase of muscle contraction, which helps to strengthen the tendon and improve its ability to withstand stress. One effective exercise is the single – leg heel drop. The individual stands on the edge of a step with the affected foot, holding onto a stable surface for balance. Then, they slowly lower their heel down towards the floor, allowing the flexor hallucis longus tendon to lengthen under the load of their body weight. This movement should be performed slowly and with control, and it can be repeated for several sets of 10 – 15 repetitions.
Another useful eccentric exercise is the seated toe curl with resistance. The person sits on a chair with a resistance band looped around the toes of the affected foot. They then slowly curl their toes, pulling against the resistance of the band, and hold the contraction for a few seconds before slowly releasing. This exercise specifically targets the flexor hallucis longus muscle and tendon, helping to build strength and endurance. Performing these eccentric strengthening exercises regularly, 2 – 3 times a week, can gradually reduce pain and improve the function of the affected tendon over time.
Ultrasound – Guided Injection Techniques
Ultrasound – guided injection techniques have become an important treatment option for flexor hallucis longus tendinopathy. Using ultrasound imaging, healthcare providers can precisely visualize the tendon and surrounding structures, ensuring accurate placement of the injection. Corticosteroid injections are commonly used, as they can reduce inflammation and provide significant pain relief. However, due to the potential risks associated with corticosteroids, such as tendon weakening, alternative injectable treatments like platelet – rich plasma (PRP) or hyaluronic acid may also be considered.
During the procedure, the patient lies in a comfortable position, and a gel is applied to the skin over the affected ankle. The ultrasound probe is then used to identify the exact location of the inflamed tendon. A thin needle is inserted under the guidance of the ultrasound image, and the medication is injected directly into or around the tendon. Ultrasound – guided injections offer the advantage of increased accuracy, reduced risk of complications, and potentially better treatment outcomes compared to blind injections.
Surgical Release Outcomes
In severe cases of flexor hallucis longus tendinopathy that do not respond to conservative treatments, surgical release may be recommended. The goal of the surgical procedure is to relieve the pressure on the tendon and remove any scar tissue or other structures that may be causing impingement. During the surgery, the surgeon makes a small incision in the posterior ankle area to access the tendon. They then carefully release any constricting tissues and may perform a debridement to clean up damaged portions of the tendon.
Post – surgery, patients typically undergo a period of immobilization to allow the tendon to heal. This is usually followed by a comprehensive rehabilitation program that includes physical therapy to regain strength, range of motion, and function in the ankle and foot. While surgical release can provide significant relief and improve the patient’s ability to return to dancing or running, the outcomes can vary depending on factors such as the severity of the initial condition, the patient’s overall health, and their compliance with the rehabilitation program. In general, a significant number of patients experience a reduction in pain and an improvement in their functional abilities, but full recovery may take several months.
Final Thoughts
Flexor hallucis longus tendinopathy is a complex condition that requires a multi – faceted approach to treatment for dancers and runners. By understanding its presentation, recognizing associated signs, implementing appropriate strengthening protocols, considering advanced injection techniques, and being aware of surgical options and their outcomes, patients can take proactive steps towards recovery and return to their chosen activities with confidence.
