Flexor hallucis longus tendon passes just behind the ankle joint along talus bone and then passes under the foot till great toe. Behind the talus it passes through a tight band of tissue which is the most tight passage of the tendon It helps in final push off during running. Any impingement at this level with chronic injury can cause a painful condition of the tendon.

Repeated forceful contraction of the tendon with extreme planter flexion can cause tendon injury. Any abnormal bone or tight fibrous band here can also cause tendon injury. Activities like ballet dancing, football, or other form of dancing required twisting may precipitate FHL tendinopathy.

Pain at posteromedial aspect ankle, difficulty in heel raise and push off, running, jumping. One can feel triggering of big toe also.

If you have any of these above symptom should visit a specialist foot and ankle surgeon.

Your doctor will evaluate your symptom and enquire about your sports or recreation activity. He will do some manoeuvre to elicit the pain. Although it is difficult to palpate the tendon as it is deep. He may ask for an x-ray and MRI. This condition can be confused with Achilles tendinopathy or posterior ankle impingement.

Rest, NSAIDs, modification of activity and splinting of ankle can help in reducing symptom. Surgical treatment is advised if there is no improvement following conservative treatment. Surgical treatment involves release and debridement of the tight fibrous band at posterior aspect of ankle either open or by posterior ankle arthroscopy.