Pyogenic tenosynovitis of the flexor hallucis longus in a healthy 11-year-old boy: a case report and review of the literature

  • Stephane Millerioux
  • Marie Rousset
  • Federico CanaveseEmail author
Up-to date Review and Case Report


Pyogenic tenosynovitis of the flexor hallucis longus (FHL) is a rare condition in young healthy patients. We report the case of a healthy 11-year-old boy who presented with a history of fever and painful swelling below the medial malleolus of the left ankle. Imaging and laboratory findings suggested infectious tenosynovitis of the FHL. Methicillin-sensitive Staphylococcus aureus was isolated on culture following surgery. Antibiotherapy was initiated and continued until inflammatory markers returned to normal. Six months post-surgery, he resumed sport activities and inflammatory markers remained within normal limits. We review also the literature and discuss the clinical characteristics of this condition.


Pyogenic tenosynovitis Flexor hallucis longus Children Surgery 


Conflict of interest



  1. 1.
    Bogoch II, Robbins GK (2012) Varicella zoster mimicking infectious tenosynovitis. J Infect 64:341–342PubMedCrossRefGoogle Scholar
  2. 2.
    Mo N, Lim V, Gregory JJ, Cool P (2010) A rare cause of foot swelling mimicking tenosynovitis. J Rheumatol 37:1977PubMedCrossRefGoogle Scholar
  3. 3.
    Brulhart L, Gabay C (2011) The differential diagnosis of tenosynovitis. Rev Med Suisse 17:587–593Google Scholar
  4. 4.
    Boya H, Pinar H (2010) Stenosing tenosynovitis of the peroneus brevis tendon associated with hypertrophy of the peroneal tubercle. J Foot Ankle Surg 49:188–190PubMedCrossRefGoogle Scholar
  5. 5.
    Anandan SM, Iyer S, Uppal R (2010) Metastases to the finger masquerading as flexor tenosynovitis. Hand Surg Eur 35:597–598CrossRefGoogle Scholar
  6. 6.
    Volpin G, Shtarker H, Oliver S, Katznelson A, Stahl S (2006) Osteoid osteoma of the wrist joint resembling tenosynovitis. Harefuah 145:885–888PubMedGoogle Scholar
  7. 7.
    Kerman BL, Mendelsohn ES (1978) Pigmented villonodular tenosynovitis: a case report. J Foot Surg 17:122–124PubMedGoogle Scholar
  8. 8.
    Grossman JM (2009) Lupus arthritis. Best Pract Res Clin Rheumatol 23:495–506PubMedCrossRefGoogle Scholar
  9. 9.
    Merle M, Bour C, Foucher G, Saint Laurent Y (1986) Sarcoid tenosynovitis in the hand. A case report and literature review. J Hand Surg Br 11:281–286PubMedCrossRefGoogle Scholar
  10. 10.
    Gillet P, Hestin D, Renoult E, Netter P, Kessler M (1995) Fluoroquinolone-induced tenosynovitis of the wrist mimicking de Quervain’s disease. Br J Rheumatol 34:583–584PubMedCrossRefGoogle Scholar
  11. 11.
    Jain NB, Omar I, Kelikian AS, van Holsbeeck L, Grant TH (2011) Prevalence of and factors associated with posterior tibial tendon pathology on sonographic assessment. PMR 3:998–1004Google Scholar
  12. 12.
    Pang HN, Teoh LC, Yam AK, Lee JY, Puhaindran ME, Tan AB (2007) Factors affecting the prognosis of pyogenic flexor tenosynovitis. J Bone Joint Surg Am 89:1742–1748PubMedCrossRefGoogle Scholar
  13. 13.
    Boles SD, Schmidt CC (1998) Pyogenic flexor tenosynovitis. Hand Clin 14:567–578PubMedGoogle Scholar
  14. 14.
    Theodore GH, Kolettis GJ, Micheli LJ (1996) Tenosynovitis of the flexor hallucis longus in a long-distance runner. Med Sci Sports Exerc 28:277–279PubMedGoogle Scholar
  15. 15. Accessed 15 June 2012
  16. 16.
    Schulhofer SD, Oloff LM (2002) Flexor hallucis longus dysfunction: an overview. Clin Podiatr Med Surg 19:411–418PubMedCrossRefGoogle Scholar
  17. 17.
    Oloff LM, Schulhofer SD (1998) Flexor hallucis longus dysfunction. J Foot Ankle Surg 37:101–109PubMedCrossRefGoogle Scholar
  18. 18.
    Kayabas U, Yetkin F, Firat AK, Ozcan H, Bayindir Y (2008) Ciprofloxacin-induced urticaria and tenosynovitis: a case report. Chemotherapy 54:288–290PubMedCrossRefGoogle Scholar
  19. 19.
    Brown JT, Miller A (1996) Peroneal tenosynovitis following acute gonococcal infection. Am J Orthop 25:445–447PubMedGoogle Scholar
  20. 20.
    Eberle CF, Moran B, Gleason T (2002) The accessory flexor digitorum longus as a cause of Flexor Hallucis Syndrome. Foot Ankle Int 23:51–55PubMedGoogle Scholar
  21. 21.
    Ogut T, Ayhan E (2011) Hindfoot endoscopy for accessory flexor digitorum longus and flexor hallucis longus tenosynovitis. Foot Ankle Surg 17:e7–e9PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag France 2012

Authors and Affiliations

  • Stephane Millerioux
    • 1
  • Marie Rousset
    • 1
  • Federico Canavese
    • 1
    Email author
  1. 1.Service de Chirurgie InfantileCentre Hospitalier Universitaire EstaingClermont FerrandFrance

Personalised recommendations