What is flexor hallucis longus tendinopathy?
Flexor hallucis longus tendon anatomy
Flexor hallucis longus is a deep muscle in the leg whose tendon passes behind the ankle, through a narrow tunnel just behind the inner ankle bone, before reaching the big toe. It flexes the big toe and plays a key role in the push-off phase of the stride, particularly when up on the toes. This tendinopathy, sometimes called “dancer’s tendinitis”, particularly affects activities that demand being up on the toes.
Why does this tendon become painful?
Pain appears when the tendon undergoes repeated friction or load in its narrow tunnel behind the ankle, particularly during repeated toe-point movements or strong push-off on the big toe. Too rapid an increase in training volume or a running technique with strong forefoot push-off are common contributing factors.
Which sports contribute to this tendinopathy?
Any sport that heavily demands being up on the toes or push-off through the big toe carries a particular risk:
- Ballet (pointe, demi-pointe)
- Running, particularly on uneven terrain
- Football and sports with fast changes of footing
- Gymnastics
- Basketball and volleyball (repeated jumping)
- Martial arts with forefoot weight-bearing
Treating flexor hallucis longus tendinopathy in rehab with a sports physio
The goal of treatment is to reduce friction of the tendon in its tunnel while progressively strengthening its capacity to absorb push-off load.
- 1Reducing pain and managing load
- 2Foot and ankle mobility
- 3Isometric strengthening
- 4Progressive concentric strengthening
- 5Eccentric strengthening
- 6Foot proprioceptive work
- 7Correcting technique and footing
- 8Strengthening under sport-specific load
- 9Progressive return to running
- 10Return to competition
Why the physio’s initial assessment matters
During the initial assessment, the physiotherapist aims to identify the movements that reproduce the pain (toe-point, push-off), your sporting practice (dance, running), and any recent change in training volume.
“It’s not that the tendon is fragile, it’s that the load needs to be better dosed and distributed.”
Strengthening, the cornerstone of treatment
Progressive strengthening of flexor hallucis longus, combined with comprehensive foot and ankle work, restores the tendon’s capacity to withstand the push-off strain specific to your activity.
In brief
- Progressive strengthening of the big toe flexor
- Comprehensive foot chain work
- Eccentric strengthening
- Gradual return: mobility, then load, then sport
Ready to take your flexor hallucis longus tendinopathy seriously?
Start the HOPP programme designed by sports physios.
Should you rest or keep playing sport?
Total rest is generally not necessary. It’s better to temporarily adapt the toe-point movements that clearly reproduce the pain, while starting progressive strengthening of the tendon.
Think you might have a different foot injury?
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When should you see a specialist for this tendinopathy?
If the pain persists for more than three to four weeks, or if you feel a mechanical blocking sensation in the big toe (sometimes linked to a nodule on the tendon), a medical opinion is recommended.
The HOPP care programmes to treat your tendinopathy and get back to sport
This tendinopathy requires progressive, well-dosed strengthening. HOPP offers you a precise exercise programme, allowing you to get back to your activities as quickly as possible.
The programme runs from 3 to 9 weeks depending on the injury and ends with a reconditioning phase allowing a return to competition in the best possible conditions. Each programme is designed by the HOPP team, made up of two sports physiotherapists who are experts in assessing and treating athletes. You’ll also find theoretical content throughout your progression, so you master every aspect of your recovery and can adjust your treatment independently. If needed, our team of physiotherapists is on hand to support you.
Essential
FROM INJURY TO
BACK TO YOUR ACTIVITIES
59€
One-time payment
“AT YOUR OWN PACE WITH
DAILY ADAPTATION”
- 100% of the treatment programme
- Daily personalisation
- Flexibility / Mobility
- Strengthening
- Proprioception
- Progress tracking
- Return-to-running programme
- Theoretical content included
Performance
TO GET BACK TO SPORT
IN THE BEST CONDITIONS
79€
One-time payment
“GET BACK TO YOUR LEVEL
WITHOUT RISK OF RELAPSE”
- 100% of the treatment programme
- Daily personalisation
- Flexibility / Mobility
- Strengthening
- Proprioception
- Progress tracking
- Return-to-running programme
- Theoretical content included
- + 4-week return-to-play plan with 6 difficulty levels
Expert
PERSONALISED VIDEO-CALL
SUPPORT, ANY TIME
149€
One-time payment
“A PHYSIO
WHENEVER YOU NEED”
- 100% of the treatment programme
- Daily personalisation
- Flexibility / Mobility, Strengthening, Proprioception
- Progress tracking
- Return-to-running programme
- Theoretical content included
- + 4-week return-to-play plan with 6 difficulty levels
- + 2 video calls with an expert sports physio / return check-up
A programme that adapts to you every day
Every day, how you feel (RPE) is factored in to automatically adjust the rest of your programme: more load if all is well, a bit less if your foot is complaining. This daily personalisation is what makes the difference compared to a fixed, paper-based programme.
Ready to start your programme?
Join the HOPP support programme designed by sports physios.
F.A.Q
Does the HOPP programme replace a medical consultation?
No. HOPP is a support and rehab tool designed by sports physiotherapists, but it doesn’t replace a doctor’s opinion. If in doubt, or if the pain persists, see a health professional.
Is the programme suited to all sporting levels?
Yes. Every programme is personalised to your sport, your level and how you feel each day, whether you’re a recreational athlete or preparing for competition.
Can I keep dancing or running with this tendinopathy?
In most cases, yes, by temporarily adapting the toe-point movements that reproduce the pain, while starting strengthening in parallel.
How long does it take to recover?
A structured programme generally brings clear improvement within a few weeks, with a full return to activity after several weeks of progressive strengthening.
Why is it called “dancer’s tendinitis”?
Because it’s particularly common among ballet dancers, due to the repeated pointe and demi-pointe weight-bearing that heavily strains this tendon.
