Flexor digitorum longus and flexor hallucis longus tenosynovitis

NewsBot · May 27, 2011

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Hindfoot endoscopy for accessory flexor digitorum longus and flexor hallucis longus tenosynovitis.
Ogut T, Ayhan E.
Foot Ankle Surg. 2011 Mar;17(1):e7-9.

We present a case report involving the flexor digitorum accessorius longus (FDAL) tendon which travels through a fibro-osseous tunnel together with the flexor hallucis longus (FHL) tendon, causing a stenosing tenosynovitis. The patient was admitted with posteromedial ankle pain and diagnosed clinically as FHL tenosynovitis. We found two tendons in the tunnel during hindfoot endoscopy. The stenosis was relieved by endoscopic debridement. After the operation, we checked the MRI images and observed two tendons. We concluded that the accessory tendon was the FDAL. Two years later the patient was admitted with the same symptoms. We excised the FDAL muscle and the patient's symptoms resolved. The FDAL muscle is a cause of FHL tenosynovitis. Because of its variability and mostly asymptomatic nature, it may not be noticed it on an MRI scan. Hindfoot endoscopy is a safe tool for the diagnosis of this condition and curative treatment is afforded by excision of the FDAL muscle.
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efuller · May 29, 2011

Two years later the patient was admitted with the same symptoms. We excised the FDAL muscle and the patient's symptoms resolved. The FDAL muscle is a cause of FHL tenosynovitis.
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Nice logic. When the patient comes back two years later (if he comes back) with the same symptoms you can have him stay off of the leg for 3 weeks and the symptoms won't come back for another 2 years.

NewsBot · Aug 3, 2019

Effect of extensive tenosynovectomy on diffuse flexor hallucis longus tenosynovitis combined with effusion.
Qu W et al
J Orthop Surg (Hong Kong). 2019 Sep-Dec;27(3)

OBJECTIVE:
The objective of this study was to examine the clinical and magnetic resonance imaging (MRI) outcomes of extensive tenosynovectomy on patients with diffuse flexor hallucis longus tenosynovitis combined with effusion (DFHLT-E).

METHODS:
Consecutive patients undergoing extensive tenosynovectomy for DFHLT-E in the same foot and ankle center from January 2013 to December 2016 were selected; a total of 14 patients were included in the final analysis. Patients with a minimum 1-year follow-up were evaluated with physical examination, MRI, American Orthopaedic Foot and Ankle Society (AOFAS) clinical midfoot scale, and visual analog scale (VAS) pain scores.

RESULTS:
The 14 patients were followed up for an average of 15.0 ± 2.3 months (12-18 months). There were no recurrences in all clinical examinations at the final follow-up. The AOFAS score was improved from 61.57 ± 10.70 before surgery to 90.28 ± 9.41 at the final follow-up. The difference was statistically significant (p = 0.001). The VAS score was improved from 4.00 ± 0.82 before surgery to 0.43 ± 0.53 at the final follow-up (p < 0.001). MRI examination revealed two patients with small residual and limited effusion with no clinical symptoms. Superficial pin infection was observed in one patient, and two patients had transient neurostimulation.

CONCLUSIONS:
Extensive tenosynovectomy is an effective alternative for the treatment of DFHLT-E with less complications or recurrence.
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