Inflammation of the Flexor Tendons of the Toes
Tendons are the fibrous extensions of the muscles that insert into the bones and move the bones as the muscles contract. The flexor tendons of the toes can be divided into:
Long tendons, which originate from the muscles of the legs, and
Short tendons, which originate within the foot.
All these tendons insert into the lower surface of the toes and help to bend or flex the toes.
There are two main flexor tendons of the toes:
Flexor hallucis longus tendon (bends the big toe)
Flexor digitorum longus tendon (bends the four small toes)
These tendons arise from the muscles of the legs; pass behind the ankle and go under the foot. Travelling forward on the lower surface of the foot, these tendons finally insert into the toes. The FHL tendon inserts as a single extension into the big toe of the foot, while the FDL tendon splits into four parts and each part inserts into its corresponding toe.
Cause and Incidence:
Inflammation of the flexor tendons of the toes is not a common finding; it is mostly seen in dancers and athletes.
The inflammation can be a result of:
Tendon injury, either direct trauma or overuse injury
Sometimes the cause is an inflammatory disease
Inflammation of the flexor tendon of the big toe is quite common among ballet dancers due to their pointe work and repeated flexion of the toes, hence the name “dancer’s tendonitis”. Sports involving frequent pushing off the forefoot such as climbing and running also increase the risk of flexor tendon inflammation.
There is pain and tenderness on the inner side and back of the ankle
Sometimes there may also be swelling in the area
Pain and tenderness along the course of the tendon on the lower surface of the foot
Pain intensifies when the toes are bent against resistance
Symptoms and physical examination are a great aid in diagnosing the condition. CT and MRI scans are the main diagnostic tools to confirm the diagnosis by showing the enlarged tendon, tendon dislocation and/or associated tears.
The initial treatment involves:
giving rest to the aching tendon and avoiding any activity that puts stress on the tendon
applying ice packs to the area for about 15 to 20 minutes every three to four hours and using nonsteroidal anti-inflammatory drugs to help control pain and inflammation.
use taping to support the foot and arch and allow the tendon to rest
massage the area to improve blood flow and promote healing
Exercises such as bending and stretching the toes and calf help to strengthen the flexor tendons, thus reducing the chances of injury or inflammation
For severe pain, foot can be immobilized using casts and crutches
If there is no improvement in the symptoms even after three to six months of rest and conservative therapy, surgery should be considered. Surgery involves repairing the tears in the tendon, correcting tendon dislocation and removing any nodules or adhesions of the tendon, allowing it to move more freely.
Surgery usually corrects the problem; however, a few months are required before the person can return to dancing or sports activities.