Flexor Hallucis Longus Word document download

What is the FHL tendon?

The flexor hallucis longus (FHL) is a tendon that runs along the inside of your ankle and under your big toe. It helps you push off when you walk or go on tiptoe. In some conditions, another tendon in your ankle or foot (often the Achilles or posterior tibial tendon) becomes too damaged to repair directly. In these cases, your surgeon may use the FHL tendon to replace or reinforce the damaged tendon. This is called an FHL tendon transfer.

 

 

Why might I need an FHL tendon transfer?  – ACHILLES TENDON DISORDERS

You may need this operation if you have a chronic or irreparable Achilles tendon tear, failed previous tendon repair, or severe tendon disease that has not improved with non-surgical treatments.

 

 

Expectations of FHL Tendon Transfer

You can expect quite significant improvement in the function of your ankle.  The ‘Push-Off’ power will feel a lot better and heel pain should improve.  Many find a complete ‘normal’ sensation to their ankle when walking and during daily function.  Sports, in particular running is  a little more guarded but cycling is certainly acheievable.

 

A Cosmetic change has to be expected! 

The FHL muscle muscle is right down behind the ankle.  As this bulks up during your rehab you should expect a permanent swelling appearance low in the calf.  This is necessary and normal for the improved function outcome.

 

 

What does the operation involve?

The procedure is done under a general or regional anaesthetic. A cut is made along the back of the ankle. The FHL tendon is detached from under the big toe and re-routed to reinforce or replace the damaged tendon. It is fixed with stitches and  small (Interference)  screw, and your foot is placed in a plaster or boot.

 

 

After the operation

You will usually go home the same day. Your leg will be in a plaster to protect the repair in downwards (Ballet dancer)position , and you must keep it elevated to reduce swelling.  “TOES ABOVE YOUR NOSE”

 

 

 

Recovery timeline

 

0–2 weeks   ‘Surgical Phase’

Rest and elevate your foot “Toes above your Nose” to keep any swelling down and optimise conditions for your wound to heal. 

• You can Toe Touch Weightbear unless your surgeon has specifically said otherwise
• Elevate the foot for approx. 45-50mins of every hour
• Eat well and stay hydrated
• Maintain good mood avoiding work or family stress if possible
• Do not travel significant distances
• Self administer the prescribed Meds including the small injection to thin your blood (Enoxaparin) unless told specifically otherwise.
• Keep the cast dry, using a specifically designed proprietary bag for bathing if necessary.Check out the Shop on my home page.

 

 

 

 

2–6 weeks  ‘Recovery Phase’

You should expect to be in a boot at this stage with a series of wedges under your heel (Usually 3-4).

• The boot should be worn at all times when walking
• You should build upo to Fully weightbearing but only “as pain allows’.Do thing that makes the surgical site / ankle hurt.
• You will likely be instructed to remove the boot repeatedly throughout the day and undertake ankle exercises guided by a physio.
  • These should be movements without resistance or pain
  • Again…..Only “Do what doesn’t hurt”.
• You will be guided on a sequence of moments to remove the wedges from the boot.Usually its at 10-14 day intervals but this is very individual.
• The boot should be worn at night unless specifically instructed

 

 

6–8 weeks ‘Rehabilitation Phase’

This is the weaning period from the boot (Without any wedges by this stage) back to normal footwear whilst walking.

• Initially a small heel wedge (1cm…See Shop on home page) is used in your shoe for 7-10 days then removed.
• An appointment with your physio will organise your rehabilitation plan
  • This will very bespoke to the condition and your personal situation

 

8 weeks – 6 months

This is time for Physiotherapy rehabilitation and a structured progressive plan will be agreed and should be adhered to. 

This operation and your function will continue to improve for well over 6 months post. Surgery.

Physiotherapy is essential to regain ankle motion, strength, and balance. Only start exercises or weight-bearing when advised by your surgeon or physiotherapist.

 

 

 

 

 

Possible risks or complications

All surgery carries risks including Bleeding, infection, swelling, stiffness, nerve damage, Great Toe Weakness, Fracture, Implant problems, Pain Reaction, Weakness, re-rupture, Poor cosmetic change or Thrombosis. Your team will discuss how these apply to you and how they can be minimised.

 

Long-term outlook

Most patients regain good strength, walking ability, and pain relief. Some may notice mild weakness in the big toe, but this rarely affects daily activity. Full recovery can take 6–12 months.

 

When to contact Mr. Williams / Oaks

Contact your surgeon or hospital if you experience increasing pain, redness, swelling, fever, discharge, calf pain, shortness of breath, or if your cast/boot feels too tight or causes numbness.

 

Key points

• The FHL tendon transfer restores strength and function when another tendon is damaged. • Protect the tendon for several weeks before gradually returning to activity.
  • Good recovery depends on following post-operative and physiotherapy guidance.