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Intermittent flexor hallucis longus dislocation: ultrasound findings

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Abstract

We report a case of intermittent dislocation of the flexor hallucis longus at its passage in the retro-malleolar area, related to a post-traumatic detachment of the retrotalar pulley from the medial tubercle of the talus. High-resolution ultrasound depicted the anterior dislocation of the tendon during dynamic stress, by asking the patient to flex his hallux against the examiner resistance, with the ankle in slight dorsiflexion. The tendon normally relocated after the dynamic maneuver. Tendon dislocation was associated with a painful snap.

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Authors and Affiliations

  1. Misericordia di Pistoia, Via Bonellina 1, 51100, Pistoia, Italy

    Marco Becciolini & Giovanni Bonacchi

  2. Scuola Siumb di Ecografia Muscoloscheletrica, Pisa, Italy

    Marco Becciolini, Giovanni Bonacchi & Salvatore Massimo Stella

  3. Swiss Ultrasound Center, Institute of Rheumatology, Basel, Switzerland

    Giorgio Tamborrini

  4. Clinic for Rheumatology, University Hospital of Basel, Basel, Switzerland

    Giorgio Tamborrini

Authors
  1. Marco Becciolini
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  2. Giovanni Bonacchi
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  3. Salvatore Massimo Stella
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  4. Giorgio Tamborrini
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Correspondence to Marco Becciolini.

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Retrotalar pulley rupture. Intermittent dislocation of the flexor hallucis longus (FHL). On the left, computed tomography 3D schematic drawings of the retrotalar pulley rupture and the intermittent FHL dislocation. On the right, the corresponding live transverse sonogram. The video clip starts with the foot at rest. The FHL is normally housed between the medial (MT) and lateral (LT) tubercles of the talus. The retrotalar pulley appears quite normal over the FHL (open arrowheads), but it looks thickened and hypoechoic (black arrowhead) over the medial tubercle and is detached from it (asterisk). Then, a stress test is performed (showed in bottom right corner). With the ankle in slight dorsiflexion, the hallux of the patient is flexed against the resistance of the hand of the examiner. The FHL can be clearly seen while dislocating anterior to the medial tubercle of the talus. The tendon relocates at the end of the stress test, in the neutral position. Supplementary file1 (MP4 2188 KB)

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Becciolini, M., Bonacchi, G., Stella, S.M. et al. Intermittent flexor hallucis longus dislocation: ultrasound findings. J Ultrasound (2024). https://doi.org/10.1007/s40477-024-00880-1

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