HSS Ultrasound of the Month Case 71

Clinical History 26 year old female ballet dancer with left posterior ankle pain and difficulty dancing en pointe An ultrasound was requested for evaluation of the flexor hallucis longus (FHL) tendon

Ultrasound of the Month – Case 71

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Diagnosis Stenosing FHL tenosynovitis

Discussion The FHL tendon, because of its function to plantarflex the great toe and because of its particular course along the posterior ankle, is susceptible to irritation particularly in ballet dancers.

Chronic irritation of the tendon can result in both tendinosis and tenosynovitis of the FHL posterior to the ankle.

Like all tendons in the foot and ankle, because the FHL courses relatively superficially in the soft tissues, it is a structure that is optimally evaluated by ultrasound.

Stenosing tenosynovitis, in which hypertrophic scarring of the tendon sheath can have a constricting effect on the tendon, can result in pain and diminished excursion of the FHL.

Ultrasound of the Month – Case 71

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