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Anatomy of the Flexor Hallucis Longus

Courtesy : Prof Nabile Ebraheim, University of Toledo, Ohio, USA

FLEXOR HALLUCIS LONGUS
• One Of The Deep Muscles Of Posterior Compartment Of The Leg
• FHL Muscle Spans Down The Calf To The Side Of Ankle And Into Foot
• Muscle Fibers – Lowest Origin In Leg And Some Fibers Almost At The Ankle

ORIGIN AND INSERTION
• FHL Muscle Arises From Posterior Surface On Inferior 2/3rds Of Fibula
• As Muscle Extends Down Into Plantar Aspect Of The Foot , Tendon Inserts Into Distal Phalanx Of Large Toe.
• FHL Muscle Is Largest And Strongest Deep Muscle Of Leg’s Posterior Section.
• There Are Two Sesamoid Bones At Level Of The MCP Joint , One Tibial And One Fibular- That Act Like Pulleys For The Flexor Tendons and are embedded in The Flexor Hallucis Brevis Muscle
• Sesamoids Are Important To The Big Toe Region By Absorbing Weight Bearing Pressure And Reducing Friction On Metatarsal Head.
• Also They Protect The Flexor Hallucis Longus Tendon As It Glides Between Two Sesamoid Bones

FUNCTION & INNERVATION
• FHL Flexes Joints Of Big Toe, And Also Role In Plantar Flexion Of Ankle Joint
• Tibial Nerve Provides Innervation To The Flexor Hallucis Longus Muscle
• Blood Supply From Peroneal Artery(Muscular Branch) And Posterior Tibial Artery (Peroneal Branch)

ARRANGEMENT OF TENDONS
• The FHL tendon has long course from its muscle origin to its insertion
• The tendon is vulnerable to wear and tear , friction and inflammation at certain anatomic locations
• At the ankle FHL located posterior and lateral to FDL and in between posterior talar processes
• The tendon lies most lateral in medial ankle compartment
• The tendon passes in its own tunnel beneath the sustentaculum tali

• Tendinopathy is common at the tibiotalar joint as the tendon curves over the posterior talus
• Flexor hallucis tendonitis mostly happens in ballet dancers and those require excessive plantar flexion at ankle
• Distal disease of hallux sesamoids is affected next, followed by area of knot of henry
• As tendons of FHL and FDL curve under medial malleolus and talus , they begin to converge and eventually cross
• At this point KNOT OF HENRY fibrous slip connects the FDL with FHL and tendon sheath communicates allowing spreading of inflammation
• Because of the intersection of two tendons , transection of digitorum proximal to the KNOT OF HENRY to correct the tibialis posterior dysfunction could result in retention of function of hallux and lesser digits

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Get Book Kendall’s Muscles: Testing and Function, with Posture and Pain, 6th Edition, transforms this landmark Physical Therapy classic to prepare you for unparalleled clinical success in today’s practice. Timeless coverage of manual muscle testing, evaluation, and treatment meets the latest evidence-based practices, engaging imagery, and dynamic digital resources to create a powerful resource you […]

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