FISSURES OF THE FLEXOR HALLUCIS LONGUS: SEVEN CASES

Abstract

Purpose: Fissures of the flexor hallucis longus, an exclusively clinical diagnosis, are often unrecognised. Imaging is not contributive. The purpose of this work was to detail the clinical signs leading to surgical exploration with tendon suture, the only effective treatment.

Material and methods: Lesions of the flexor hallucis longus, generally subsequent to ankle sprains resulting from trauma involving the medial border of the foot or from a fall, were found in the retrotalar gutter (1 patient), at the Henry node, the pulley of the common flexors and the flexor hallucis longus under the navicular bone (6 patients). Palpation produced exquisite pain. Pain was also provoked by movement of the great toe, explaining why the patients were unable to run or stand tiptoed. Ultrasound and MRI were negative. Surgery was peformed because of the persistent pain which did not respond to medical treatment (anti-inflammatory drugs, corticosteroid injections, plantar orthesis maintaining the medial vault, plaster cast). Surgical repair relieved pain in all cases and enabled renewed activities within three months on average. The treatment consisted in suture of the tendon associated with regularisation of the retrotalar gutter as needed and, at the subnavicular level, section of the Henry node and anastomosis of the flexors. Cast immobilisation was recommended for four to six weeks.

Conclusion: In patients complaining of pain of the posterior crossway or in the subnavicular region, examination of the flexor hallucis longus should be undertaken to search for a fissure which requires surgical tendon repair. It is hoped that improved imaging techniques will provide a means of confirming the diagnosis before surgery.