Despite these improvements at 4 months postinjection, return to dance required a total of 9 months due to symptoms localizing to the flexor hallucis longus
Caption: FIGURE 2: Dissection of left leg and foot to show accessory flexor digitorum longus muscle (AFDL: accessory flexor digitorum longus muscle; CT: calcaneal tendon; FDL: flexor digitorum longus tendon; FHL: flexor hallucis longus
tendon; TP: tibialis posterior tendon; QP: quadratus plantae muscle).
Treatment commenced two weeks after the initial injury occurred and included soft tissue therapy (Active Release Technique[R] and instrument assisted soft tissue mobilization) on the gastrocnemius, soleus, flexor digitorum longus, flexor hallucis longus
, tibialis posterior, tibialis anterior and fibularis muscles, as well as a plan of rehabilitation exercises.
Tracing distal branches of the tibial nerve to the lower sciatic was possible for functional groups of nerves such as the group of primary, weight-bearing plantar flexors (gastrocnemius and soleus) and the group including an inverter and weak plantar flexor (tibialis posterior) and other weak plantar flexors (flexor digitorum longus and flexor hallucis longus
) (Figures 5 and 7).
These include edema or enhancement of posterior soft tissue, indicating posteriortibiotalar joint synovitis (100%) due to repetitive compression and posteriorcapsular thickening; fluid around the flexor hallucis longus
(FHL) tendon or synovial enhancement, suggesting tenosynovitis of the FHL (68%); and high signal changes and/or enhancement within the musculotendinous junction of FHL muscle belly due to impingement.
Flexor Hallucis Longus
(FHL) tendon transfers are commonly used in the repair of chronic Achilles tendon ruptures.
Beneath these muscles are the posterior tibialis and flexor hallucis longus
. The posterior tibialis enables the foot to turn inward at the ankle and the flexor hallucis longus
controls flexion or downward motion of the big toe.
Endoscopic all-inside repair of the flexor hallucis longus
tendon in posterior ankle impingement patients.
Manual muscle testing of the left quadriceps, extensor hallucis longus, tibialis anterior, flexor hallucis longus
, and tibialis posterior was grade 3/5.
FHL, flexor hallucis longus
, v1 & v2 are vena comitantes
Expose and mobilize by careful dissection, the tendons of the tibilalis posterior, flexor digitorum longus, and flexor hallucis longus
and the posterior tibial neurovascular bundle.