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FLEXOR POLLICIS LONGUS TENOSYNOVITIS
Have you ever wondered which mechanism is activated every time you flex the great toe? The answer lies in the flexus hallucis longus, the muscle which rises from the lower region of the posterior surface of the tibia and is inserted into the plantar surface of the great toe. Besides flexion, it is also “responsible” for the maintenance of the foot arch. Its anatomical path through the bones of the foot makes it vulnerable to irritation due to overuse - especially for ballet dancers who use the pointe shoe position, especially if their technique is poor, and degeneration and inflammation (tendonitis) are quite frequent symptoms. Besides, it is a condition known as the “dancers’ tendonitis”.
CAUSES
Recent studies have shown that the flexus hallucis longus tendonitis, which is quite painful, may even be related to poor quality footwear, leg misalignment (pronation), weak muscles, lack of stretching, or poor recovery after the injury. Apart from dancers, the “high risk” group includes gymnasts, swimmers, footballers, long distance runners and ice skaters.
Moreover, 7-10% of the adult population has an extra small bone at the posterior part of the ankle. This bone (referred to as “os trigonum” in the literature), depending on its size and chronic repetitive plantar flexion, can act as a “nutcracker”: It compresses the tendon of the flexus hallucis longus of the great toe and causes tendonitis. A concomitant back foot impingement syndrome is also frequent, which results in pain and a kind of jamming in the range of the great toe movement (this is considered as the equivalent of the trigger finger).

WHY IS ARTHROSCOPY AN EFFECTIVE TREATMENT OPTION?
Conservative treatment usually includes orthopedic insoles for 6 weeks, however, if the pain persists, the orthopaedist may suggest surgery. Nowadays, the arthroscopic technique is an effective option, compared to open surgery, even in a joint such as the ankle, which requires thorough knowledge of the area, in order for complications to be minimized.
Through two or three very small holes, the surgeon will insert the arthroscope and surgical instruments, in order to release the tendon, clean the inflamed area, and, if necessary, remove the os trigonum. Postoperatively, the patient shall have to wear an orthopedic boot for about 2 weeks. Recovery of the entire range of movement is also gradual, through appropriate physiotherapy.

 

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