Posterior Ankle Arthroscopy for Flexor Hallucis Longus Entrapment: A Case Report

Introduction: Stenosing tenosynovitis is a chronic disorder frequently observed in finger triggering of a digit. Regarding the toes, although entrapment of the flexor hallucis longus (FHL) has already been reported in a few cases among sports players, the clinical condition is uncommon. Besides, the case without any specific causes is particularly rare. Case Report: We report the case of a 26-year-old male with FHL entrapment. Even though he was unaware of any cause, he felt tenderness on the posteromedial side of his left ankle, and his great toe was locked in the flex position. Magnetic resonance imaging indicated effusion in the tendon sheath of the FHL and the possibility of a partial tear of the FHL. We hypothesized that the scar tissue secondary to the partial tear of the FHL may have been irritated at the retrotalar pulley below the sustentaculum tali, where the FHL glides. Therefore, posterior ankle arthroscopy was performed for the treatment of the FHL entrapment. Conclusion: Orthopedic surgeons should list this pathology as a differential diagnosis of posterior ankle pain, even in non-athletes. Keywords: ankle arthroscopy, flexor hallucis longus, stenosing tenosynovitis.

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Posterior Arthroscopic Treatment of a Massive Effusion in the Flexor Hallucis Longus Tendon Sheath Associated with Stenosing Tenosynovitis and Os Trigonum

Case Reports in Orthopedics ◽

10.1155/2020/6236302 ◽

2020 ◽

Vol 2020 ◽

pp. 1-7

Author(s):

Ichiro Tonogai ◽

Koichi Sairyo

Keyword(s):

Rare Case ◽

Tendon Sheath ◽

Flexor Hallucis Longus ◽

Great Toe ◽

Os Trigonum ◽

Longus Tendon ◽

Rare Case Report ◽

Stenosing Tenosynovitis ◽

Posterior Ankle Arthroscopy ◽

Massive Accumulation

We report a rare case of massive accumulation of fluid in the flexor hallucis longus tendon sheath with stenosing tenosynovitis and os trigonum. A 34-year-old woman presented to our hospital with pain and swelling in the posteromedial aspect of the left ankle joint after an ankle sprain approximately 8 months earlier. There was tenderness at the posteromedial aspect of the ankle, and the pain worsened on dorsiflexion of the left great toe. Magnetic resonance imaging revealed massive accumulation of fluid around the flexor hallucis longus tendon. We removed the os trigonum, performed tenosynovectomy around the flexor hallucis longus, and released the flexor hallucis longus tendon via posterior arthroscopy using standard posterolateral and posteromedial portals. At 1 week postoperatively, the patient was asymptomatic and able to resume her daily activities. There has been no recurrence of the massive accumulation of fluid around the flexor hallucis longus tendon as of 1 year after the surgery. To our knowledge, this is a rare case report of extreme massive effusion in the flexor hallucis longus tendon sheath with stenosing tenosynovitis and os trigonum treated successfully by removal of the os trigonum, tenosynovectomy around the flexor hallucis longus, and release of the flexor hallucis longus tendon via posterior ankle arthroscopy.

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Posterior ankle arthroscopy for posterior ankle synovitis with an enlarged posterior talar process caused by a cat bite or scratch: A case report

International Journal of Surgery Case Reports ◽

10.1016/j.ijscr.2021.105761 ◽

2021 ◽

Vol 81 ◽

pp. 105761

Author(s):

Ichiro Tonogai ◽

Koichi Sairyo

Keyword(s):

Case Report ◽

Ankle Arthroscopy ◽

Posterior Ankle Arthroscopy

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Arthroscopic Treatment of Flexor Hallucis Longus Tenosynovitis

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00301 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0030

Author(s):

Joseph Labrum ◽

Thomas Harris ◽

Stephen Shymon ◽

Harinee Maiyuran

Keyword(s):

Ankle Joint ◽

Outcome Measures ◽

Classification Scheme ◽

Short Form ◽

Plantar Flexion ◽

Ankle Arthroscopy ◽

Preoperative Imaging ◽

Flexor Hallucis Longus ◽

Effective Treatment Option ◽

Posterior Ankle Arthroscopy

Category: Arthroscopy Introduction/Purpose: Flexor Hallucis Longus (FHL) tenosynovitis is a common cause of posterior ankle pain, typically associated with repetitive plantar flexion activities. The purpose of this study was to report the results of patients with FHL tenosynovitis treated with posterior ankle arthroscopy using validated outcome measures and develop a zone-based classification of FHL tenosynovitis that demonstrates well correlated preoperative imaging and intraoperative findings. Methods: Posterior ankle arthroscopy was performed in 11 patients (12 ankles) with a diagnosis of FHL tenosynovitis, with patients followed for a minimum of two years (mean 44 months). Outcomes were evaluated using validated scoring measures, including visual analog scales (VAS) for pain, 12-Item Short Form Health Survey (SF-12), and the Foot and Ankle Ability Measure (FAAM). Results: A zonal classification scheme based on anatomic location was developed, divided into three zones: proximal to the ankle joint, posterior to the ankle joint, and from the fibro-osseous tunnel underneath the sustentaculum tali to the FHL insertion. Agreement between preoperative MRI and arthroscopic zonal involvement at time of surgery was present in ten feet (83%), and differed in two feet (17%). VAS scores improved significantly from 7.1 ± 1.4 preoperatively to 1.3 ± 1.3 postoperatively (p <0.001). Mean values for ADL and sports subscales of the FAAM at time of follow up were 87.1 ± 16.2 and 76.5 ± 28.8, respectively. Physical component summary (PCS) and mental component summary (MCS) of the SF-12 yielded means of 51.3 ±12.8 and 52.7 ± 5.0, respectively. Conclusion: FHL pathology can be classified using a zone-based classification scheme, which is highly correlative between preoperative MRI and intraoperative findings. Posterior ankle arthroscopy is an effective treatment option for FHL tenosynovitis, as evaluated using validated outcome measures.

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Giant cell tumour of tendon sheath with simultaneous two tendon involvement of the foot treated with excision of the tumour and reconstruction of the flexor retinaculum using tibialis posterior tendon in a paediatric patient: A rare case report

Foot and Ankle Surgery ◽

10.1016/j.fas.2015.08.004 ◽

2015 ◽

Vol 21 (4) ◽

pp. e60-e63 ◽

Cited By ~ 4

Author(s):

Vivek Tiwari ◽

Tahir Ansari ◽

Samarth Mittal ◽

Pankaj Sharma ◽

Aasma Nalwa

Keyword(s):

Case Report ◽

Paediatric Patient ◽

Giant Cell ◽

Rare Case ◽

Giant Cell Tumour ◽

Tendon Sheath ◽

Cell Tumour ◽

Tibialis Posterior ◽

Tibialis Posterior Tendon ◽

Rare Case Report

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A rare case report of giant cell tumor of a tendon sheath

International Journal of Medical Science and Public Health ◽

10.5455/ijmsph.2016.19082015114 ◽

2016 ◽

Vol 5 (4) ◽

pp. 829 ◽

Cited By ~ 2

Author(s):

Ankit Patel ◽

Parth Thaker ◽

Ruchir Patel ◽

Mahesh Ladumore ◽

Mukund Prabhakar

Keyword(s):

Case Report ◽

Giant Cell Tumor ◽

Giant Cell ◽

Rare Case ◽

Tendon Sheath ◽

Cell Tumor ◽

Rare Case Report

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Posterior Ankle Arthroscopy for Osteochondromatosis of the Posterior Ankle Extra-Articular Space with a Longitudinal Tear of Flexor Hallucis Longus

Case Reports in Orthopedics ◽

10.1155/2020/6580472 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Ichiro Tonogai ◽

Koichi Sairyo

Keyword(s):

Ankle Arthroscopy ◽

Flexor Hallucis Longus ◽

Loose Bodies ◽

Arthroscopic Technique ◽

Posterior Ankle Arthroscopy ◽

History Of ◽

History Of Pain ◽

The Right ◽

Longitudinal Tear

We report a rare case of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of flexor hallucis longus (FHL). A 77-year-old woman was referred to our hospital with an approximately 4-year history of pain and swelling in the right posterior ankle joint without obvious trauma. The pain had worsened in the previous 2 years. On presentation, she had tenderness at the posteromedial and posterolateral ankle. Imaging revealed several ossified loose bodies in the posterior ankle extra-articular space. We removed the loose bodies, performed tenosynovectomy around the FHL, and released the FHL tendon using a posterior arthroscopic technique via standard posterolateral and posteromedial portals. A longitudinal tear and fibrillation were detected in the FHL. The patient was able to return to her daily activities approximately 3 weeks after surgery. At the 1-year follow-up visit, she continued to have minor discomfort and slight swelling on the posteromedial aspect of the right ankle but had no recurrence of the ossified loose bodies. To our knowledge, this is the first report of osteochondromatosis of the posterior ankle extra-articular space with a longitudinal tear of the FHL that was treated by removal of loose bodies, tenosynovectomy around the FHL, and release of the FHL tendon via posterior ankle arthroscopy.

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Gout in the Flexor Hallucis Longus Tendon Mimicking Cellulitis: A Case Report

Journal of the American Podiatric Medical Association ◽

10.7547/18-161 ◽

2020 ◽

Vol 110 (1) ◽

Author(s):

Jun Ohnishi ◽

Naoto Ishimaru ◽

Hiroyuki Seto ◽

Yohei Kanzawa ◽

Saori Kinami

Keyword(s):

Case Report ◽

Synovial Fluid ◽

Fluid Collection ◽

Final Diagnosis ◽

Tendon Sheath ◽

Flexor Hallucis Longus ◽

Fluid Analysis ◽

Synovial Fluid Analysis ◽

First Case ◽

The Right

A 65-year-old Japanese man was admitted to our hospital with fever and inflammation of the right ankle. We initiated antibiotics on suspicion of cellulitis. After no clinical improvement, we performed magnetic resonance imaging, which showed a fluid collection in the flexor hallucis longus (FHL) tendon sheath. Synovial fluid analysis revealed monosodium uric crystals. Final diagnosis was FHL tendonitis secondary to gout proven by synovial fluid analysis. To our knowledge, this is the first case report of FHL tendonitis caused by gout. When ankle inflammation is examined in clinical situations, FHL tendonitis caused by gout should be considered.

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