Flexor hallucis longus synovitis

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nandystam
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Flexor hallucis longus synovitis

Postby nandystam » Tue Dec 15, 2015 12:52 pm

Hi all

I've been diagnosed via ultrasound with "Synovitis around the proximal aspect of the flexor hallucis longus tendon" via ultrasound. I sustained this via running on a treadmill a few months ago, which I initially thought was nothing serious, but hasn't gone away.

I've had a cortisone injection which didn't help, and I've sought some advice from a podiatrist who has put me on a strengthening program which is effectively calf raises and stretches. My GP wanted to refer me to a surgeon but I'm trying to hold off on that unless its an absolute necessity.

The podiatrist seems to think cycling will not affect this negatively - in his view it doesn't put any load on the tendon. But is this really true? I don't really notice any pain or change in discomfort while riding.

What other non-invasive treatment options might be available? How long does it normally take for this to go away?

eeksll
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Re: Flexor hallucis longus synovitis

Postby eeksll » Thu Dec 17, 2015 3:31 pm

Not sure if you are aware, but being referred to a surgeon does not mean you will go down the route of having surgery.

I was referred to a surgeon from the doc, the surgeon said yes he could do knife stuff but first thing to try was to so some physio and see how that goes first.

Of the 3 surgeons I have seen, none are that knife happy.

vosadrian
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Re: Flexor hallucis longus synovitis

Postby vosadrian » Tue Sep 13, 2016 9:08 am

Hi,

I'm just wondering how this worked out for you?

I have been treated for Achilles tendon related issues for about 2 years, but a recent MRI revealed this FHL tendon as being the cause of my pain (in both ankles!!). Got cortisone yesterday and it did not hurt as much as normal getting up this morning (but feels tender if not painful today probably from the injection bruising), but still early days for a cortisone shot. Just taking it easy sitting at my desk today and will rest it as much as possible for a week or so.

Cheers,

Adrian

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g-boaf
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Re: Flexor hallucis longus synovitis

Postby g-boaf » Tue Sep 13, 2016 11:08 am

I've had my own similar issues to what Adrian has mentioned (well, I partially tore the achilles tendon).

For me, they recommended (after a period of limited walking) the usual heel raises and stretches, doing them on one leg, and not using anything else for balance. No surgery needed, but with a stern warning from the physio to follow the recovery to the letter or it'll be chronic.
nandystam wrote:Hi all

I've been diagnosed via ultrasound with "Synovitis around the proximal aspect of the flexor hallucis longus tendon" via ultrasound. I sustained this via running on a treadmill a few months ago, which I initially thought was nothing serious, but hasn't gone away.

I've had a cortisone injection which didn't help, and I've sought some advice from a podiatrist who has put me on a strengthening program which is effectively calf raises and stretches. My GP wanted to refer me to a surgeon but I'm trying to hold off on that unless its an absolute necessity.

The podiatrist seems to think cycling will not affect this negatively - in his view it doesn't put any load on the tendon. But is this really true? I don't really notice any pain or change in discomfort while riding.

What other non-invasive treatment options might be available? How long does it normally take for this to go away?
I think with riding, the safest option might be indoor training on rollers or a stationary trainer. That way you can control things more easily. Outdoors on a real ride, if it goes wrong when you are 40km from home, then you are in big trouble. I would recommend taking it very cautiously based on my own recent experience. The fact that your pain hasn't one away is worrying.

vosadrian
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Re: Flexor hallucis longus synovitis

Postby vosadrian » Tue Sep 13, 2016 4:55 pm

I am well over two years since my ankle problems started. Over that time it has changed. My symptoms never really matched what others had on the net for achilles but they were closest so treated with heel drops etc but never improved. Also tried EWST, PRP, Cortisone, acupuncture and more). Several rest periods up to 4-5 months with no real change and constant pain despite no activity (but worse with activity). If I have ridden in that time I was managing my loads (2-3 rides a week max) to limit my pain. Had an OK season of riding 9/15-4/16 doing this but got sick of the pain and stopped riding in April as riding in the cold is not worth the pain. Hoped the rest would cure it, but it didn't.

Recently got a new MRI done and achilles looks good, but FHL tendon does not. I don't know if that has been the cause the whole time? Radiologist said there was some fluid in FHL sheath in earlier MRIs, but worse in recent MRI. Cortisone yesterday. Need a week or two to see if it helps to determine if that is the issue. If not back to the drawing board. It looks like FHL rehab is similar to achilles anyway, so the rehab I have done in the past should have helped FHL as well. I did a period of lots of swimming to keep fit when off the bike, and FHL is noted as being prevalent in swimmers, so maybe that did it? Might end up under a surgeon eventually?

Either way, hope to ride again soon... will probably have to manage the pain again like last season. It sucks coming back after 5 months off. Will be months before I can keep up with my usual bunch.

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g-boaf
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Re: Flexor hallucis longus synovitis

Postby g-boaf » Wed Sep 14, 2016 5:37 pm

I did acupuncture as well, it helped with reducing the swelling around my ankle (that went up terrible at the start).

I had a look at Google and noticed one article suggesting surgery to solve your problem, but they were referring to the problem in ballet dancers, who put a lot of stress on their feet and ankles, not cyclists. They also expressed a lot of caution about cortisone injections as well.

Either way it sounds like a long time off from riding. :(

vosadrian
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Re: Flexor hallucis longus synovitis

Postby vosadrian » Fri Sep 16, 2016 2:18 pm

Cortisone is one of those things. You never really want to put it anywhere near tendons, but if you tried everything else and the only other option is surgery, it is worth a try as surgery has more risks than a single cortisone with careful rehab afterwards. I am 4 days after cortisone and not noticing much difference. Maybe a little better in the mornings and after sitting at my desk for a while. I will start doing some stretch/strengthening now and start a very slow return to cycling in a week or two. There was a time mid last cycling season for me when it felt OK for a few weeks. Not sure if I overdid it after that, but it did feel better at that time than any time I was resting it... maybe this season will see it get a bit better?

FHL is supposed to be a dancers thing. Not sure how I got it as a cyclist if that is what I have. I do know I tense up my feet a lot when riding at 50+%. My big toes get sore from pushing down on the soles of my shoes, so I may have damaged it from this.

But nothing about what I have has ever been typical or even similar to other people. I recently had a hernia repaired. Hernias are supposed to be the most common surgery performed and diagnosis is supposed to be straight forward. It took me about 15 months with the last few months at my insistence of getting more scans/specialists appointments to finally have a good radiologist see that something was not right where I had pain in my groin. A surgeon then went in to remove an unexplained mass (only doing the surgery because it could have been something sinister) and found it was a hernia and repaired it. The same surgeon had told me I did not have a hernia (along with 3-4 other doctors). He could not explain why he had not detected it as a hernia previously other than to say "sometimes this happens". Nothing health related is ever straight forward with me!! I don't blame the doctors. For some reason I just seem to present with strange symptoms that cannot be definitively explained?? If I had not been so pushy with the doctors I would still be lying on the lounge in pain every evening doing rehab for a muscle disorder that I didn't have.

Cheers,

Adrian

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g-boaf
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Re: Flexor hallucis longus synovitis

Postby g-boaf » Fri Sep 16, 2016 3:12 pm

Jesus, you've been through the wars! The operation sounded like a pretty serious one from the way one doctor described it. :shock:

Just a thought, how do you pedal? Quite toes down, or relatively flat? How are your shoes for support across your whole foot?

But I guess it can also be helped by strengthening all the other muscles through the legs, glutes, etc, improving flexibility, the whole lot. It's all linked together in one way or another and if something is wrong in one place, it can cause problems elsewhere in your body.

vosadrian
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Re: Flexor hallucis longus synovitis

Postby vosadrian » Fri Sep 16, 2016 5:57 pm

Yes, I have been in the wars, but life was good before that and I had been very healthy for 40+ years so I can't complain. I think one thing set everything else off. At least the hernia is sorted and I feel better than a few months ago, but still recovering from surgery to some extent for that.

I pedal more toes down. Always have, but when the ankle problems started I was trying to adjust that a little whilst also being on the biggest riding time I have done (1000kms in 6 days). I thought the heel down may have caused it, but I don't think that anymore. I have not pedaled much in the last 5 months (a few 5k rides with the kids) so it is unlikely to be pedal technique that is stopping it getting better (though it may have contributed to the initial cause).

I think it was just overuse and never recovered. The MRI also revealed I have an accessory muscle in the area of the FHL tendon making me more susceptible to impingement type issues. I suspect that is why I can't get it sorted properly where others can. It was good enough to keep well until I overdid it, and now the muscle is causing friction because of inflammation that I cannot get on top of.

nandystam
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Re: Flexor hallucis longus synovitis

Postby nandystam » Sat Sep 24, 2016 4:17 pm

Sorry it took me so long to get back to this thread.

Doing a *lot* of weighted calf raises seems to have done the trick. Sometimes it flares up and I just go back to doing more calf raises than I normally would. The basic routine is 3 sets of 20 reps for each calf, raise up at normal/faster speed and come down at about half speed (so raise up fast, come down slower). I would do this maybe 3-4 times a week in a bad period, and maybe 1-2 times a week otherwise.

vosadrian
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Re: Flexor hallucis longus synovitis

Postby vosadrian » Tue Sep 27, 2016 10:32 am

nandystam wrote:Sorry it took me so long to get back to this thread.

Doing a *lot* of weighted calf raises seems to have done the trick. Sometimes it flares up and I just go back to doing more calf raises than I normally would. The basic routine is 3 sets of 20 reps for each calf, raise up at normal/faster speed and come down at about half speed (so raise up fast, come down slower). I would do this maybe 3-4 times a week in a bad period, and maybe 1-2 times a week otherwise.
Thanks for that. What sort of weight are you using and is this single leg at one time (so raise up and lower down on the same single leg... unlike the keel drops I have done for achilles where I raise on good leg and lower on bad leg). Is this also on a flat ground or off a step?

Thanks again!

enduro2
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Re: Flexor hallucis longus synovitis

Postby enduro2 » Tue Nov 08, 2016 11:52 pm

[ Edit: Though its been a while]I've been a sports coach (20 years), massage practitioner and keen on anatomy and fixing my own bits where I can for a long time ... but I'm not a doctor.

I would recommend going to a sports therapy physio or sports massage therapist for assistance. You may even be able to remedy the problem yourself or stave off surgery. Learn the pathway of where your flexor hallucis longus runs along your leg and run you fingers firmly down it. Have you got a spot along that muscle thst is extremely tight, painful? If so that will likely be a cause of muscle shortening and irritation to the underlying tissue further down the length. You might find some remedies you can try online or learn to use one of these: (CjwKEAiAjIbBBRCitNvJ1o257WESJADpoUt0vllVNvpPlgMWBjFaPfk8KegBmYcZHUouXwzpty5nExoCMSvw_wcBl) which have helped me a lot.

Short of getting one of those use a 2L soft drink bottle filled with water (or soft drink!) and get to work on that tight spot. You will need to repeat regularly and if it's he treatment you are after it will create relief. You might need to revisit the area and the cause of the injury. My problem is likely from my desk job and using my right leg as the sole one I use to clip in and take off at stops when cycling.

Hope that helps.

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