Is it possible to correct Flexor Hallucis Longus Tendonitis and if so how?

by Shawna

I joined the military with no foot problem that I was aware of.

I was required to run many times every day for 6 weeks. I not only ran "accidently" in sneakers for flat footed people but also in combat boots.

I have very high arches. I'm 23 and no history of injuries. It is occuring in both of my feet. I've been tossed from doctor, to doctor, to physical therapist, to podiatrists, to some more doctors and back in physical therapy.

The podiatrist seemed to be the only one with a clue and then I PCS'd to another base.

I have custom made insoles to support the arch.

The doctors first believed it was plantar fasciitis and once the podiatrist said Flexor Hallucis Longus tendonitis they agreed with him.

I've had the extremely painful shots into the tendon protruding from the bottom of my arch.

I've had little electrical pads stuck to the bottom of the arches with constant low charges. I've had massage therapy. I've done different stretches. I've had ice(very painful). I've also had heat. The heat and massaging felt pretty good but it was just temporary relief. The cold even just weather seems to tighten the tendon and make it very stiff and painful.

I now have running shoes for high arches but it is still painful to run and my feet hurt for days after. I cannot wear my insoles in my running shoes because the pain becomes almost unbearable.

The insoles in my boots don't seem to be doing a whole lot. They were made for support of my arches not comfort.

My most recent doctor suggested memory foam insoles and to just discard my support insoles.

The physical therapist said the other insoles weren't working so try soft ones.

I have heard there is debate on long term and short term effects of soft insoles. Is there some kind of treatment I can mention to the doctor or physical therapist or stretches that will make a difference or maybe just some insoles you can suggest?

I'm desperate. They are putting me through physical therapy one more time then they are going to discharge me medically if I don't show improvement.

I don't know if I left anything out.

Please let me know if you need more information or if you can suggest anything.

Thank you-- Shawna


Joshua Answers:

Hi Shawna.

The quick answer to 'how' did you get this tendonitis is...'you suddenly started running everyday, multiple times, in flat shoes and combat boots'.

Lots of other variables, of course, but that seems like the obvious, general on. But you knew that.

I'm not going to investigate the direction too far.

The other quick answer is 'Yes, it is possible to correct Flexor Hallucis Longus Tendonitis.

Tendonitis is Tendonitis.

I'm going to go with what the podiatrist said. Flexor Hallucis Longus until I see/hear otherwise..

Soft inserts, hard inserts, I don't know. I've never really heard much great about them. Granted, I mostly only work with people that everything else has failed them.

The one line you said of built for support and not comfort....that seems like a bad idea. The body does not like discomfort or pain.

Thanks for all the details by the way. Details GOOD.

Not surprised by anything about the rest, doctors and PT and such. Hopefully the new PT you get will be able to get better results and do things differently than you've experienced.


1. Describe the massage you received for this. Where did they work, how did they work, etc. Details.

2. What about icing was painful? How did you ice, exactly. How did it hurt?

3. Describe the pain. Where exactly. When exactly (ie, only when you're on them, even when your off them, at night in bed, etc)

Answer the above, and we'll go from there.

Joshua Tucker, B.A., C.M.T.
The Tendonitis Expert

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Dec 18, 2009
PART 2 - Response - Is it possible to correct Flexor Hallucis Longus Tendonitis and if so how?
by: Shawna

They massaged from the edge of my heel up to where my toes begin. It was a circular motion with low to moderate pressure. Mostly focusing on the swollen tendon. I do this myself at times. It seems to relieve pressure(the throbbing).

The heat was like a heated ultrasound wand with jelly moving back and forth along my arch. The ice was shaped like a small cup but rounded on the end. I was instructed to slide it back and forth along the arch. I'm not exactly sure why the ice makes it hurt. It is most likely that the tendons are swollen and the ice makes them want to tighten rather quickly.

If I stay off my feet all day they don't hurt. My job requires me to stand a majority of the day. Just standing makes them hurt. I can't stand still for more than 5-10 minutes without teetering back and forth from one foot to another.

Jumping and running obviously hurts the most.

Walking for a prolonged amount of time also makes them hurt. This may not be helpful but running barefoot in the sand does not make them hurt.

Depending on the distance it may be a very dull ache after. The stretches range from laying down with a piece of rubber wrapped around the bottom of my foot and extending my feet, to pressing half of my foot against the wall and moving my waist towards the wall and the same but bending my knee and moving it towards the wall and holding it for 30 seconds.

I was instructed to do this for 5 minutes 5 times a day.

The stretch with the rubber doesn't bother me but the stretch with my foot against the wall just makes the top of my foot that connects my toes to my foot hurt more than the arches. I stopped those because then my whole foot is killing me instead of just my arches.

Dec 18, 2009
PART 3 - Is it possible to correct Flexor Hallucis Longus Tendonitis and if so how?
by: The Tendonitis Expert

Joshua Comments:

Just from what you've said, they've missed a vital part of all this. Seriously missing the boat.

They're working the tendon, but not the muscle that attaches to the tendon.

You HAVE to work the muscle and connective tissue. It is TOO TIGHT, connective tissue is shrinkwrapping and trapping it too tight, and that is putting constant tension on the tendon and attachements, and then the whole ecology of the foot/lower leg is responding to that.

Here's what you do, intensely for the next week.

1. Get a 5 gallon bucket and ice dip as described on the How To Reduce Inflammation.

As many times as possible per day. Morning noon and night if possible.

2. Do the massage, and even ice massage if you want, up the tendon to the muscle. For right now, don't worry about the tendon. Worry about the muscle. Trace the tendon up to muscle, and work the entire body of the muscle, and anything around it.

You do it, and/or get a friend or massage person to work your entire lower leg and especially the FHL belly and attachments and surrounding tissue.

Shift your focus from the foot to the lower leg.

Much of the time, where you hurt isn't the source of the problem.

3. Read this Magnesium for Tendonitis page and then my Kerri's Magnesium Dosage to find out what kind of mag and how much to take. Work up to your tolerance level and stay there.

It will be worth it for you to also get this Magnesium Oil and apply it to the FHL/lower leg area, and the foot too. (It's the best and cheapest you will find.)

I'm not saying the above is a total answer, but it's the answer for right now to lower your pain levels.

Go full tilt at this for the next 7 days.

* Ice as much as possible.

* Massage in little bits, frequently and repeatedly, even while you're standing there at work, reach down and rub the FHL for 10 seconds. Repeatedly.

* Magnesium, and increase your protein intake too.

More questions, more answers. And, updates please.

Nov 21, 2010
FHL pain in foot
by: Anonymous

I came across this site while looking for info on FHL tendonitis. I thought that what I had was plantar fasciitis, but none of the treatments (strassburg sock, golf ball rolling, etc.) have helped, plus the pain/tenderness is only on the medial part of my arch stretching from under the big toe to below and behind the ankle bone.

My question is what else, besides what you've listed above, can be done for this?

I'm a runner, would putting the foot in a boot for a few weeks help?


Joshua Comments:

Ahhh! No! No Boot!!!

Granted, that's just my personal/professional opinion.

You have pain because something(s) is TOO TIGHT. IF you immobilize it in Das Boot, then it gets no lengthening or shortening, and connective tissue shrinkwraps the half squeezed sponge of the muscle even more than it already is.

Then you'd have a too short, too tight structure that puts even MORE tension on it's connections with every step.

So no, I don't suggest immobilization in the boot.

Sure, I have other things I could suggest. But my question to you is, have you done what has been suggested in this thread?

If no, do them and check back in later.

If yes, then describe what exactly you did, and the results.

Jan 15, 2011
barefoot training and kickboxing, now arch pain
by: Fipzee

hello, I stumbled acrosse this page while searching for answers about my strained arches. Very good advice here!!

I have been training Muay Thai kickboxing for the past 3 years and have returned to training after a 3 month layoff. We train barefoot on a padded floor, however after 3 sessions in a week and a half i had to stop because of what felt like a pulled arch. I do have fairly flat feet and wear custom orthotics in my shoes and haven't had issues training before. I think it's due to the return to barefoot training. During the 3 months off I was still running and exercising though.

It has been 1 week and I have been icing and doing self massage, no stretching yet as it is slightly painful when stretched still. My question is should I be stretching the arch during recovery and about how long would you estimate this will take before I can get back to training? (only thing i've been doing is swimming in the meantime)

p.s. I am a 37 yr old male

thanks for the help!


Joshua Comments:

Hi Fipzee.

I wouldn't worry about the arch so much, I'd work on the back of the lower leg.

It's a big shift to go from shoes to barefoot training. So while you feel it in the feet, and it possibly is the feet, but I bet it's more a function of lower leg structures that connect down in the feet.

Release those tight structures, happier feet.


Feb 09, 2011
It's working! (slowly)
by: Fipzee

Hi, thanks again for your advice. I have been stretching and rolling my lower legs daily. I have also been stretching the plantar fascia and i try and do strengthening exercises like walking on toes etc. I think all this is working. It has been 4 weeks now since hurting the arches and they definately feel better but not 100%

I wouldn't say i have anymore PF "pain", however they are a little tight in the morning and maybe slightly tender when pushing my thumb on it.

I'm wondering when is a good time to start back with short runs? I not even considering kickboxing for a while.



Joshua Comments:


Are you rolling/working/stretching the backs of your lower legs? I'd hit that before running. It's great to open up the plantar fascia, but if you don't open up the back of the lower leg.....

Mar 01, 2011
Posterior Tibialis Tendonitis Misdiagnosed?
by: barefoot

Just came upon your page here. I too have had very similar symptoms and been in the same situations as Shawna. I too have high arches, been in the military, have issued custom made insoles which I do not wear because of discomfort. Love to be barefoot at home, not a big fan of wearing shoes and socks after hours. Recently about 4 weeks ago was on my feet for several hours in boots shoveling out from the two feet of snow here in the Midwest. Later that evening I went to stretch up my foot and felt a severe 2" inch tear on the inside of my ankle. Saw my Ortho and told me I had PTT, was referred to PT 2 X 3 weeks. During PT of Massage, Ultrasound and Icing experienced much pain and discontinued therapy after 2nd session. Went back to see Ortho and felt that a Richie Brace and returning to PT would help. My ankle is still pretty active as far as pain level of 7+. During PT was told I have tight muscles and still guarding. I am considering having a MRI done to see if something was missed. Would very much like your opinion on my situation. Thanks!


Joshua Comments:

Hi Barefoot.

It would be very useful to know whether or not you actually do have a tear or not.

It's either VERY tweaked and unhappy, or there's a tear.

The treatment methodology is similar for both, but depending on the specifics of the tear, or if there -is- a tear or not to ligament or connective tissue or tendon, that does change the game as far as how one looks at what's going on in your feet.

Aside from that, yes absolutely your muscles are tight and guarding.

What are you doing about that?

Also, when you say 'inside the ankle', does that mean in the meat of the foot, or on the bony area on/below the ankle bone?

Feb 20, 2012
2 1/2 years!!
by: Anonymous

I just wanted to share a condensed version of my story. I've been dealing with the same arch pain for about 2 1/2 years following a rolled ankle. Went into the walking boot for about 8-10 weeks( stress fractures) and when I came out of the boot the arch pain was 10 times worse than the stress fractures and it has lingered and turned into other problems.

The good news is that I have a rather obsessive personality and was/ am determined to fix this. I have discovered that a great deal of the pulling of the tendon at the ankle and heel (which has lead to a stiffening of my big toe) has a large part to do with what is going on at the very top of the fhl tendon at the top of the leg.

With the proper walking and alignment mechanics the hip should be turned out a bit as you walk thereby giving length to the tendon. Also my back and hip are crunched over and pinching it which is also restrictive.

My wife has shown me a few yoga poses which to my amazement have given me relief(during the poses).

I am now starting yoga and PT with a sense of extreme optimism.

Good luck to you all.

Feb 21, 2012
Tarsal Tunnel Release/Bone Spurs
by: Barefoot

Just saw your comments to my post of March 2011. Here is an update on my condition. Back in April 2011 I had a Tarsal Tunnel Release done with good results.

The MRI I had done did not show a tear however, it did show that I had spurs on the insertional part of my Achilles Tendon and several micro tears.

I did extensive therapy for eight weeks afterwards consisting of Stretching, Strengthening exercises and building up my calf muscles. My ankle has been pretty quiet until recently.

Lately, I have been experiencing a somewhat painful tearing sensation when walking or standing on occasion (barefoot & in shoes)at the back of my heel (A/T area). The only thing right now that gives me some relief is a Dr. Scholls insert for heel spurs and plantar fascitis.

Really do not want to seek medical attention if I can avoid. Any suggestions would be appreciated.


Joshua Comments:

Hi Barefoot.

1. My Reversing Achilles Tendonitis ebook or 'The Plantar Fasciitis Treatment That Works' DVD and the Quick Start Companion ebook that comes with it will go a long way towards rehabbing the ecology of your lower leg.

Stretching and strengthening will never work, because the problem isn't something Stretching or Strengthening can fix. You're feeling tearing again because all the same factors that caused the bone spurs and microtears in the first place were not fixed with surgery nor PT.

Did you have the bone spur's removed?

I need to do a page on bone spurs...

Depending on your motivation levels, what I REALLY suggest is The ARPwave System. That will fix the SOURCE of the problem, which is NOT the bone spurs or micro tears, etc.

Mar 05, 2012
Achilles Tendonitis/Bone Spurs
by: Barefoot

Very much appreciate your updates to my feet concerns. Such some additional info - it is only effecting my right foot (odd?) not sure. Also, my pain issues seem to really get worse when walking up and down stairs especially and of course being barefoot on my hard floors. No I did not have the bone spur's removed, perhaps I should have? Not sure. Thanks for the suggestions I most certainly will look into obtaining the information you mention above and look forward to reading about your page on bone spurs.


Joshua Comments:

Bone Spur page

Nov 26, 2012
Did this work?
by: Interested

Hello - can you give an update as to if the suggested treatment for FHL (as asked by the original poster) worked?


Mar 24, 2013
by: Anonymous

I have been doing the Insanity video no socks and jogging on my treadmill barefoot but with socks. I haven't been dealing with this pain 2 years but it's going on 2-3 months and recovery is so slow it's not seeming likely unless I put my foot in a cast.

My left leg has some tendonitis but not as bad as my would be nice to see feedback of what has worked for others..started for me every other day I'd workout to Insanity video no socks and I stepped it up to where I was sometimes jogging on treadmill or interval sprinting on my non-video days.

I think I just overused the muscle..but I starting noticing bc I would get charlie horses so bad during the video I had to stop. I was eating less than ever too but taking vitamins.. I wanted to lose weight and was having a hard time..I started giving myself a week break btw workouts bc the charlie horses were SO bad.. and I started introducing everything recommended to treat muscle cramps into my diet like spinach, red meat, fish, sesame seeds, dried apricots etc.. but this didnt seem to fix the charlie horses during the workout video..and the last workout was the last straw.. intitially I thought sciatic nerve bc the workout caused my butt muscles, thigh calves to be soar..then it became my calves and my arches of my foot and big toe and somewhere btw my little toes..I started to think it was a nerve..primary care dr apt as it is taking 2 wks to fit me in.. so I have yet to diagnose and take antinflamattory meds and properly diagnose it.

Haven't worked out in about 3 wks, I do still wear high heeled boots to work but I sit all day and only get up to visit the fridge or potty breaks at work, and to travel to and from my car btw leaving work. Otherwise I spend most of my time laying around.

I would THINK recovery would be faster...I have taped my arches the last week and tried taping my foot like I am a ballerina today.. I may find out more information from my primary care doctor..but I wish I could find more answers worst I might buy some crutches however both my legs have it somewhat mostly my right.


Joshua Comments:

The body can't recover if it doesn't have (enough of the) the neccessary building blocks.

See: Magnesium For Tendonitis

Not enough magnesium causes muscle twitch, spasm, cramp, charlie horse.

Also, were you used to going barefoot during activity? Or did you just all of a sudden start not wearing shoes to work out?

Mar 07, 2014
12 year old daughter dx with FHL tendinitis
by: Kenja

I, too, stumbled across this page while searching for info on FHL tendinitis. I have a 12 year old daughter who was running in gym class and out of the blue, the back of her left ankle (like where the Achilles Tendon is) started hurting very badly and she says that every time she takes a step & has to push off, it hurts.

It's slightly swollen. She's has had this problem before when it started about 1.5 years ago when she started playing soccer. Before, with rest, it just gradually went away but it hasn't this time. Sometimes, both ankles hurt in the same spot just one worse than the other.

She went to an Orthopaedic Dr who dx her with FHL Tendinitis. She has a very high arch & wears chuck's (low top chuck taylor shoes) or a different pair of high top sneakers (don't know the name right off). What is the best kind of shoe & what exercises will be best? (We're talking about a highly ticklish little 12 year old girl & I'm not sure how effective any exercises will be if she's too ticklish).

Also, should I take her to get fitted for custom insoles (the chuck's have no arch support in them at all & her high-tops don't offer much support either).

Thank you very much!


Joshua Comments:

Hi Kenja.

1. I"m not a fan of insoles or inserts. Sometimes they can work out fine...but I'd prefer to fix the problem/get the body working how it's supposed to.

'High arches' aren't in and of themselves a problem. The problem is, muscles aren't working properly so pain develops.

2. Rest doesn't make the problem go away, but it does reduce new irritiation to an already irritated.

What does her nutritional intake look like?

Oct 01, 2014
FHL Tenosynovitis and still in pain after multiple surgeries
by: Anonymous

I was diganosed with FHL (flexor hallucis longus) Tenoysnovitis in 2012 after having an os trigonum excision. Two FHL tenosynovectomies surgeries later (December 2013 and July 2014), I still continue to have chronic pain. I have been to seven different doctors to try to fix this problem.

I have been booted, given custom orthotics, soft tissue massage, heat, TENS Unit, stretching, isometrics, icing, ultra sound, and injections.

Do you have a specific program for FHL injuries or have an suggestions?


Joshua Comments:

Hi Anonymous.

Your scenario is involved and significant so I'm not going to give you a tip or a trick, because that wouldn't work.

The best I have for you is 'The Plantar Fasciitis Treatment That Works' DVD and the Quick Start Companion ebook that comes with it.

You need a complete plan of attack that deals with your foot and lower leg and entire system (for certain factors). Post-all-these-surgeries you also need to deal with the repercussions of the multiple surgeries that have caused damage and injury.

Unfortunately surgery doesn't deal with what caused the tenosynovitis in the first place. So that's part of what the plan of attack deals with.

Due to the surgeries that have damaged and rearranged and weakened your structures, our goal is 1. reduction of pain and symptoms then 2. see how good we can get your function and pain levels.

What did you have the first surgery for?

Nov 11, 2014
Is this Flexor Hallucis Tendonitis?
by: Tiffany

I have a quick question for you... While I continue to have pain and issues after my tibial sesamoidectomy, bunionectomy, and fusion of second toe procedures (from April of 2013), I have been pushing along using orthotics, TENS, stretching, PT, etc.

I find that trekking in woods or doing some hikes (granted, I have been learning my limits...) is easier than walking on flat land, as I don't have to push off as much... I also row, use weights, and do Pilates/yoga to stretch and strengthen...
y PT thinks I need to focus more on using my ankles/other muscles instead of my toes as much when I walk. With my high arch, I realize that I will continue to have issues after all of the surgical procedures, but I will live with it.

That said, I am curious--my last MRI from a couple of months ago showed that I had "thickening of the flexor hallucis tendon near the lateral sesamoid", which is thought to be due to "chronic stress injury and/or post-surgical changes."

This was shown on the MRI from April as well. Can this be considered flexor hallucis tendonitis? I am just trying to figure out how to approach it at this point, as when I have very bad pain cycles, the first met head (right in ball of foot) is very painful to the touch, and feels inflamed constantly.

It hurts no matter what I do. So when I am active, I make SURE to sure to use orthotics or rocker shoes, apply Voltaren gel, etc. Thank you for any input/ideas you might be able to offer!

This has been a long and frustrating process, and it's pretty difficult to rest my foot now that I am no longer willing to wear Das Boot! ;)


Joshua Comments:

Hi Tiffany.

There's a variety of things I could say, but let's start with: Do you have any specific questions for me?

Nov 12, 2014
FHL tendonitis?
by: Tiffany

Yep! The title of my post--"Is this FHL tendonitis?" is probably what I'd most like to know! I'm open to any suggestions, too!!


Joshua Comments:

Hi Tiffany.

Well I can't diagnose for a number of reasons legal and otherwise..

If you have pain and problem with your Flexor Hallucis then it's safe to call it tendonitis. Which techinically means that there's inflammation of the tendon, but realistically means that muscle and connective tissue are too short and tight, that there's an inflammation process making things hurt worse, and nutritional insufficiency.

You had surgery and had things removed, so absolutely other structures are going to be working harder, thickening, working less well, etc.

Surgery didn't fix the factors that caused the original problems, so that's still in play too as well as everything that happens post-surgery.

Point being, maybe yes a doctor might call it flexor hallucis tendonitis, but the reality is, there's a bigger picture than that at play (which your doctor doesn't know about and can't help you with, and maybe a REALLY good PT can help you with).

Personally I would get my Reversing Achilles Tendonitis ebook and apply everything in it to your foot/lower leg/upper leg.

You MUST do the nutrition, deal with chronic inflammation in the foot and lower leg, and do the specific massage on lower leg and upper leg as well.

You have a lot going on. I suggest you cover the necessary basics that have been neglected, get the benefits from that and see what happens with that, and then we can re-evaluate.

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