What is it?
It is a condition where fibrosis of an intersection between a flexor hallucis longus as well as the flexor digitorum longus tendons is reported and the flexor digitorum longus tendon, as well as the fibrous interconnection is extended proximally.
This condition is happen in the foot, at the intersection of the flexor hallucis longus and flexor digitorum longus tendons.
Muscles involved are Flexor Hallucis Longus and Flexor Digitorum Longus
What is the cause?
Cause is due to repetitive toe flexion as well as plantar flexion and inversion exercises or activities.
It is most commonly seen in sporting activities, such as soccer or football. It can also happen due to sudden injury to the muscles or direct injury.
What really happens?
The FDL tendon crosses superficially over the FHL in the plantar midfoot at the knot of Henry, which is usually located over the navicular and medial cuneiform in most patients. This anatomic relationship creates a mechanically disadvantageous site similar to the intersection syndromes of the upper extremity. A fibrous slip connects the FHL and FDL at the knot of Henry, which tends to maintain their anatomic relationship at this location. The tendon sheaths of the FHL and FDL usually communicate, which allows inflammation of one structure to spread to the adjacent tendon.
Repetitive toe flexions as well as plantar flexion and inversion activities can result in friction injury at the crossover junction of the flexors hallucis longus and flexors digitorum longus muscles tendons, leading to the inflammatory response and subsequently the tenosynovitis. There may also be swelling and crepitus that is palpable on the exam with foot plantar flexion, inversion, and toes flexion.
Another tendon intersection site has been identified in the lower leg as the FDL crosses superficially over the posterior tibial tendon, called the chiasma crurale. However, there is no reported clinical impingement syndrome at this site, and histologic examination of cadaveric tendons at this location did not reveal significant tendon degeneration
Pain and tenderness of the foot tendons,
Inflammation at the tendons,
Swelling of the tendons,
The grinding sensation (crepitus) with the movements of the toes and fingers.
Anti inflammatory medication and
Surgery (required in case of persisting symptoms after an already adequate course of conservative treatment)
Physical Therapy Management
Physical agents or electrotherapy
Soft tissue mobilization
Stretching (plantar fascia, Achilles tendon, Flexor Hallucis Longus) and
Strengthening exercises(toe heel rocks, single leg stand, toe splays, toe curls
Education on activity modification
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