Understanding Flexor Hallucis Longus Tendinopathy and How Physiotherapy Can Help

Pain around the inside of the ankle, along the arch of the foot, or near the big toe can sometimes be linked to irritation of the flexor hallucis longus (FHL) tendon. Flexor hallucis longus tendinopathy is a condition affecting the tendon that helps bend the big toe and plays an important role during walking, running and activities that require pushing off through the foot.

At Belconnen Physiotherapy Clinic, we regularly see people in Canberra seeking help for persistent foot and ankle pain that affects their exercise, sport, work or daily activities. Understanding the cause of symptoms is an important first step towards developing an appropriate management plan.

What Is Flexor Hallucis Longus Tendinopathy?

The flexor hallucis longus is a tendon located deep at the back of the lower leg. It runs behind the ankle and connects to the base of the big toe. Its main role is to assist with bending the big toe downwards and providing stability during the push-off phase of walking and running.

Flexor hallucis longus tendinopathy occurs when the tendon becomes painful and sensitive, often due to repeated loading over time. It is commonly seen in runners, dancers, athletes and people who regularly perform activities involving repetitive toe movement or strong push-off forces.

Common contributing factors may include:

• Sudden increases in training volume or intensity

• Repetitive running, jumping or dancing movements

• Changes in footwear or training surfaces

• Reduced strength or control around the foot and ankle

• Limited mobility in the ankle or big toe

• Repeated stress without adequate recovery

What Are the Symptoms of Flexor Hallucis Longus Tendinopathy?

Symptoms can vary between individuals, but common signs may include:

• Pain along the inside of the ankle

• Discomfort around the arch of the foot

• Pain near the base or underside of the big toe

• Increased symptoms during running, jumping or walking uphill

• Tenderness along the tendon pathway

• Stiffness or discomfort after periods of rest

Some people notice symptoms only during activity, while others may experience ongoing discomfort that affects everyday movement.

If you are experiencing persistent foot or ankle pain, a physiotherapy assessment can help determine whether the flexor hallucis longus tendon may be contributing to your symptoms.

How Is Flexor Hallucis Longus Tendinopathy Diagnosed?

A physiotherapist will usually begin with a detailed assessment, including questions about:

• When your symptoms started

• Activities that increase or reduce pain

• Your exercise, sporting or work demands

• Previous injuries or changes in training

The assessment may include looking at foot and ankle movement, strength, balance, walking patterns and specific movements that load the tendon.

In some cases, further medical assessment or imaging may be considered depending on your presentation. A physiotherapist can help guide you on whether additional investigations may be appropriate.

How Can Physiotherapy Help With Flexor Hallucis Longus Tendinopathy?

Physiotherapy for flexor hallucis longus tendinopathy focuses on improving your ability to manage load, reduce aggravating factors and restore function.

Your physiotherapist may recommend a combination of strategies such as:

Exercise-Based Rehabilitation

Progressive strengthening exercises are often an important part of tendon rehabilitation. These exercises aim to gradually improve the capacity of the tendon and surrounding muscles to tolerate everyday and sporting demands.

A rehabilitation program may include:

• Calf and foot strengthening exercises

• Big toe and foot control exercises

• Balance and stability exercises

• Gradual return-to-running or sport-specific exercises

The exercises provided will depend on your symptoms, goals and activity requirements.

Managing Activity Loads

One of the key principles in managing tendon pain is finding an appropriate balance between activity and recovery.

Your physiotherapist can help you understand:

• Which activities may be contributing to your symptoms

• How to modify training without unnecessary restriction

• How to gradually increase activity levels safely

Addressing Contributing Factors

Treatment may also consider other factors that influence foot and ankle function, including:

• Ankle mobility

• Foot strength and coordination

• Running technique

• Training habits

• Footwear considerations

Frequently Asked Questions About Flexor Hallucis Longus Tendinopathy

Can you walk with flexor hallucis longus tendinopathy?

Many people can continue walking with FHL tendinopathy, although symptoms may increase with longer distances or higher-demand activities. A physiotherapist can help identify appropriate activity modifications while maintaining movement where possible.

How long does flexor hallucis longus tendinopathy take to improve?

Recovery time varies depending on factors such as symptom severity, activity demands, tendon capacity and consistency with rehabilitation. Tendons often require gradual progression of loading rather than quick changes.

Should I stop running if I have FHL tendon pain?

Not necessarily. Some people may be able to continue running with appropriate adjustments, while others may need temporary modifications. A physiotherapy assessment can help determine a suitable approach based on your individual circumstances.

Can physiotherapy help with foot and ankle tendon pain?

Physiotherapy can assist with many tendon-related conditions by addressing contributing factors, improving strength and helping people return to their desired activities.

Physiotherapy for Flexor Hallucis Longus Tendinopathy in Canberra

If you are experiencing pain around your ankle, foot or big toe that may be related to flexor hallucis longus tendinopathy, the team at Belconnen Physiotherapy Clinic can help assess your symptoms and develop an individualised management plan.

Early assessment can provide a clearer understanding of your condition and the steps that may help you return to your usual activities with confidence.

Book an appointment with Belconnen Physiotherapy Clinic in Canberra today to discuss your foot or ankle pain and find out how physiotherapy may help. Contact our clinic to arrange your assessment.

Book online HERE!