Flexor Hallucis Longus Tendinopathy

What is Flexor Hallucis Longus Tendinopathy?

Flexor hallucis longus tendinopathy is an injury affecting the flexor hallucis longus tendon, which connects a muscle in the lower leg to the big toe.

The flexor hallucis longus muscle runs:

• Down the back of the lower leg
• Behind the bony bump on the inside of the ankle (medial malleolus)
• Along the inside of the foot to the big toe

Its main functions include:

• Bending the big toe
• Helping push the body forward during walking or running
• Supporting balance and stability during movement

When this tendon becomes irritated or overloaded, it can lead to pain, swelling, and reduced ankle or foot movement.

This condition is commonly seen in:

• Runners
• Dancers
• Athletes performing repetitive push-off movements

How Does Flexor Hallucis Longus Tendinopathy Happen?

Flexor hallucis longus tendinopathy usually develops due to repetitive overuse of the tendon.

Repeated stress on the tendon can cause microscopic tears in the tendon fibres.

In response, the body triggers an inflammatory repair process. However, if the tendon continues to be overloaded without adequate rest, the inflammation can persist, resulting in:

• Tendon irritation
• Pain
• Reduced function

Common contributing factors include:

• Repetitive running or jumping
• Sudden increase in training intensity
• Poor footwear support
• Tight calf muscles
• Abnormal foot biomechanics

Without proper treatment, the condition may gradually worsen.

What Are the Symptoms of Flexor Hallucis Longus Tendinopathy?

Symptoms often develop gradually and may initially be mild.

Common symptoms include:

• Pain behind the inside of the ankle
• Pain along the inner side of the foot
• Stiffness in the ankle, especially in the morning
• Swelling or tenderness around the tendon
• Pain when pushing off the big toe during walking or running
• Difficulty rising onto the toes
• Discomfort when performing calf raises

In the early stages, symptoms may improve temporarily with:

• Movement
• Massage
• Heat therapy

However, continuing activity without treatment may cause symptoms to progress and become persistent.

What Should I Do If I Have Flexor Hallucis Longus Tendinopathy?

If you suspect flexor hallucis longus tendinopathy, early treatment is important to prevent further tendon damage.

You should consider:

• Resting the affected foot
• Avoiding activities that aggravate pain
• Applying ice to the inside of the ankle
• Seeking professional physiotherapy assessment

Ice can be applied using a cold pack or bag of frozen peas wrapped in a cloth for 15–20 minutes every few hours to help reduce inflammation.

At ACE Physio Sports – Singapore, physiotherapists provide thorough assessments and develop personalised rehabilitation programmes to treat tendon injuries.

Physiotherapy Treatment for Flexor Hallucis Longus Tendinopathy

Physiotherapy plays a key role in treating flexor hallucis longus tendinopathy and restoring normal tendon function.

Following an assessment at ACE Physio Sports – Singapore, treatment may include several rehabilitation strategies.

Activity Modification

Reducing activities that place excessive strain on the tendon allows it to heal.

Ice Therapy

Cold therapy helps reduce inflammation and relieve pain.

Manual Therapy

Soft tissue massage and joint mobilisation techniques help relieve tension and improve mobility in the ankle and foot.

Stretching Exercises

Stretching exercises help improve flexibility in the:

• Calf muscles
• Foot muscles
• Achilles tendon

Strengthening Exercises

Progressive strengthening exercises help improve tendon resilience and support normal movement.

Biomechanical Assessment

Physiotherapists assess foot posture and walking patterns to identify contributing factors.

Custom orthotics or footwear adjustments may be recommended if necessary.

Education and Return-to-Activity Guidance

Patients receive advice on safely returning to exercise while preventing reinjury.

These treatments help:

• Reduce tendon pain
• Improve ankle and foot mobility
• Strengthen supporting muscles
• Prevent recurrence of the injury

What Should I Avoid With Flexor Hallucis Longus Tendinopathy?

To allow proper healing, certain activities should be avoided.

Avoid:

• Continuing exercise despite pain
• Running or jumping during early recovery
• Ignoring tendon pain
• Sudden increases in training intensity
• Wearing unsupportive footwear

Ignoring symptoms may worsen tendon damage and prolong recovery.

Can There Be Long-Term Effects?

Flexor hallucis longus tendinopathy usually resolves well with early diagnosis and appropriate treatment.

If left untreated, the condition may progress to chronic tendon pain or reduced ankle function.

With proper physiotherapy and rehabilitation, most patients can achieve full recovery and return safely to normal activities.

Why Choose ACE Physio Sports

ACE Physio Sports – Singapore provides specialised physiotherapy treatment for sports injuries, foot and ankle conditions, and musculoskeletal rehabilitation.

Our physiotherapists design personalised rehabilitation programmes to restore strength, mobility, and performance.

Patients benefit from:

• Experienced physiotherapists
• Personalised treatment plans
• Evidence-based rehabilitation techniques
• Sports and musculoskeletal specialists
• Modern physiotherapy facilities

Our East Coast Road clinic serves patients from nearby areas including:

• Marine Parade
• Katong
• Joo Chiat
• Siglap
• Bedok
• Telok Kurau

We help patients safely return to daily activities, sports, and exercise.

Book an Appointment

To arrange an appointment, please call +65 81535374 or visit acephysiosport.com.