Massage therapy · Kitchener–WaterlooFlexor Hallucis Tendon Injury
Foot
What It Is
The flexor hallucis longus is a muscle that bends your big toe. The tendon of this muscle attaches to the end bone of your big toe. Whenever the muscle contracts or is stretched, tension is placed through the tendon. If the tension becomes too much, from excessive repetition or force, the tendon can be damaged. Flexor hallucis tendon injuries usually involve irritation and gradual wear (degeneration) of the tendon, which is called tendinopathy.
The injury can occur from more force going through the tendon than it can withstand, or from wear and tear caused by overuse. Ballet dancers, who spend a lot of time up on their toes, are prone to this condition (Mikkelsen et al., 2023).
Flexor Hallucis Tendon Injury Anatomy
The flexor hallucis longus muscle starts at the back of the outer lower leg bone (fibula). It runs down the back of the lower leg, passes behind the inner ankle bone through a narrow tunnel, and continues under the foot, where its tendon attaches to the base of the end bone of the big toe (Kawada et al., 2024). It is the main muscle that bends the big toe, although a smaller muscle in the foot (flexor hallucis brevis) also helps. It also helps to point the ankle and foot downward and helps you rise onto your toes.
Not a diagnosis — for more information, contact me or another trusted healthcare provider.
Treatment
Self-Care & Treatment
How to Treat Flexor Hallucis Tendon Injuries
Treatments you may want to discuss with your family doctor or nurse practitioner
Tips
- Return slowly and gradually to your regular daily activities to avoid further injury.
- Try to include exercises that improve flexibility, strength and balance in your daily routine to help restore muscle strength.
- Warm up properly before exercising and stretch gently afterwards (NHS, 2023).
- Take regular breaks from repetitive exercise, and do not over-exercise tired muscles (NHS, 2023).
Treatment
My Approach
Flexor hallucis tendon pain usually comes from asking the tendon to handle more than it's ready for, often with a lot of time up on the toes, as in ballet and other dance. My aim is to settle the tendon, then build its strength gradually so it copes with your activities again, while changing whatever has been overloading it.
I start by assessing your foot, ankle and big toe: how they move, the strength of your calf and toe muscles, your balance, and how you walk, rise onto your toes and land. I'll also ask about your training, dance or sport, and your footwear.
In a Flare
- Cutting back the activities that aggravate it, rather than stopping everything
- Gentle, pain-free movement of the ankle and big toe
- Leaving the sore tendon mostly alone, and working the calf and the muscles along the back of the leg and under the foot
- Gentle mobilisation for stiff joints in the ankle, foot and big toe
- Cool applications in the clinic, and I'll show you how to use ice safely at home
- Taping to offload the tendon for a while, and I'll show you how to tape it yourself
As It Settles
What to Expect
Typical Course
What I Focus On
Please read
When to See a Doctor First
When to get medical help
- See your family doctor or nurse practitioner if your symptoms do not improve within a few weeks (NHS, 2023).
- If the pain came on suddenly and severely during an activity, perhaps with a popping or snapping sound, you may have torn (ruptured) the tendon and should get urgent medical advice (NHS, 2023).
Sources
References
- Mikkelsen, P., Andersen, A., Shih, H.-J.S. et al. (2023) 'Flexor hallucis longus tendon morphology in dancers clinically diagnosed with tendinopathy', Journal of Ultrasound, 27(1), pp. 41–49. doi: 10.1007/s40477-023-00793-5
- Kawada, T., Shinohara, Y., Kurihara, T. et al. (2024) 'Anatomical evaluations of the adipose tissue surrounding the flexor hallucis longus tendon', Scientific Reports, 14, 16903. doi: 10.1038/s41598-024-67831-y
- NHS (2023) Tendonitis. Available at: https://www.nhs.uk/conditions/tendonitis/ (Accessed: 8 October 2026).