Injury Fact Sheet: Dancer’s Tendonitis

By on November 17, 2012

Flexor hallucis longus | Photo credit: Gray's Anatomy (public domain)
Flexor hallucis longus | Photo credit: Gray’s Anatomy (public domain)

Description:

Flexor hallucis longus (FHL) tendonopathy (or tendonitis) is an overuse injury in which repetitive plantarflexion and dorsiflexion (pointing and flexing) of the foot lead to inflammation of the FHL tendon. This tendon originates in the middle of the posterior fibula and runs down the back of the ankle along the bottom of the foot to insert at the joint between the great toe and the first metatarsal. The site of inflammation is typically in the back of the ankle at the point when the tendon runs behind the talus through a fibrosseous tunnel.

Causes:

Dancer’s tendonitis is more common in female ballet dancers who spend a lot of time en pointe or demi pointe. FHL tendonitis may occur as a primary condition, or as a secondary condition of os trigonum impingement syndrome. Failure to properly treat inflammation can result in a nodule (obstruction of the fibrous tunnel the tendon runs through) or partial or complete tear of the tendon.

Treatment:

If FHL tendonitis is diagnosed, refrain from pointe work until the inflammation subsides. Also, take an inventory of the dancer’s technique–especially the alignment of the feet. Forcing turnout to the extreme causes the inner ridge of the foot to roll in, which can either lead to or exacerbate FHL tendonitis. Conservative treatments include anti-inflammatory drugs, ice and physical therapy. Surgery should be a last result when all other approaches fail. Recovery from FHL surgery can take over 3 months and permanently reduces the range of motion in the sagital plane (pointing and flexing).

Of note:

The FHL is also used in taking off and landing from jumps. FHL inflammation can also be caused by repetitive jumping (especially if the dancer fails to press the heels into the floor), or spend long amounts of time in grand plié. FHL Tendonitis can also occur as a secondary condition in dancers with bunions.

FHL tendonitis is sometimes mistakenly diagnosed as posterior tibial tendonitis, as both are characterized by tenderness at the posteromedial ankle (soft area between the “ankle bone” and heel on the inside of the leg). A consequence of FHL tendonitis is functional hallux rigidus, in which the dancer is unable to complete a full demi pointe due to reduced dorsiflexion at the metatarsophalangeal (MTP) joint with knee extension and ankle doriflexion.

** Note: Fact sheets are compiled from peer-reviewed resources, and is intended for reference only.  For a complete list of references, click here.  In the event of an injury, seek advice from a licensed health professional.  The original content of this site is protected by copyright and may be shared, but not be republished without permission.  For full disclaimers and disclosures, visit our policies.

 



4 comments on “Injury Fact Sheet: Dancer’s Tendonitis

  1. Shelly, steroid injections such as cortisone provide temporary relief, but are a controversial treatment. Some research suggests that long-term use of cortisone can lead to permanent damage. It also may lead to further injury because it masks symptoms but does not aid in recovery. For that reason, I do not include it here. Thank you for commenting!

  2. My daughter seems to have this problem. Has had x-ray and MRI done with some physical therapy and has stopped dancing pointe for 5 months but not dance all together. She takes all different types of classes and all totaled spends 15 hours at the studio a week, a bit more during nutcracker season. just came from a third doc (specializes in sports foot injuries)… tendinitis it is and is making her foot immobile, in a boot for 4 weeks and then some therapy again. oh.. forgot to mention dancing since 4 years old and in now 15 going on 16. could you tell me (your best opinion on) how much of this is technique? and how much it is just her body and overuse? Trying to chart the best course of action moving forward. she does have some talent and has been accepted to a few summer intensive programs in NYC and wants to dance while in college. Thank you for your time and consideration Joe C

    1. Hi Joe, Without knowing your daughter I can’t say if there’s some technical issue with her dancing that’s contributing to the injury, but overuse injuries and technique go hand in hand. It’s probably worth a discussion with her dance teachers, who can evaluate her technique and hopefully prevent future flare-ups as she gets back to 100%. Your daughter is at an age where everything feels critical! But it’s important to keep the big picture in mind and plan for a very long career by taking the rest she needs and following her doctors’ recommendations. There have been a few articles published elsewhere about attending summer intensives while injured and how to make the best of it if she can’t dance fully or at all. It can still be a really great learning experience provided everyone (parents, dancer, doctor, teachers) is on board. Good luck!

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