HSS Ultrasound of the Month Case 127

Clinical History 40-year-old male with plantar foot pain associated with exercise.

Ultrasound of the Month – Case 127

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Ultrasound of the Month – Case 127

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Diagnosis: FHL tenosynovitis distal to the knot of Henry.

The FHL courses from the ankle to the great toe by passing through the tarsal tunnel.

The most common site of FHL impingement is at the posterior ankle, occurring in those who perform repetitive plantar flexion of the great toe.

FHL impingement can also occur at the master knot of Henry, where the FHL and FDL tendons cross over each other.

These tendons can easily be assessed using ultrasound.

On ultrasound, FHL tenosynovitis will present with thickening of the tendon as well as its tendon sheath.

Added advantages of ultrasound are the ability to perform dynamic maneuvers (e.g. applying tension to the FHL tendon by dorsiflexing the great toe), as well as applying pressure with the ultrasound probe to pinpoint the area of patient’s symptomatology (“sonopalpation”).

Ultrasound of the Month – Case 127

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