Flexor hallucis longus (big toe flexor tendon) Injury

Dear Ask The Doctor:  About a year ago I was in martial arts and I was thrown and landed on my big toe. I went to the hospital and took xrays, nothing was broken, just a lot of swellen. About 5 months later swellen went down and I was not able to bend my toe unless I took my finger and bend it. I have moderate pain when I do that. I went back to my doctor and took another xray and went to a specialist. They said the do not see anything on the xray. Its been over a year now and I still cannot bend my toe. I have done physio for about two months have a little better motion but not much. Any ideas of what I can do?

Dear Patient:  According to your description of the events, most likely you experienced a Injury of the flexor tendon of the big toe, called: Flexor hallucis longus (FHL), this tendon flexes the great toe  acting along with the flexor hallucis brevis at the foot and assists in plantar flexion of the foot at the ankle. It is frequent to see this kind of injury in Ballet dancers as they go from flat foot to the en pointe position, maybe similar mechanism  that happen to you one year ago during practicing Martial Arts as you described above. Tendinitis of the FHL tendon is rarely seen in activities other than ballet dancing, in which extreme plantar flexion is necessary. The symptoms of tendinitis and/or tear: swelling, pain and tenderness when try to flex the toe. The treatment options vary from local icing, taping the foot to protect the arch and allow it to rest more easily, anti inflammatory medication and physical therapy for a tendinitis, to a surgical repair if the tendon is ruptured. I strongly recommend that you get an appointment with a orthopedic surgeon who can re assess the status of your Flexor Hallucis tendon and together decide what would be the best treatment option for you.

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