Coping with Injury



Jim S

 The Flexor Hallucis Longus tendon.  Anyone ever watch the musical, “The Music Man?”  There is a song called, “Ya Got Trouble," sung by Robert Preston in the movie version.  Tear your flexor hallucis longus and as the lyrics of the song warn, “ya got trouble my friend,” only this time it starts with a capital "FHL" instead of a "T."

The Injury

This injury is usually a result of repetitive stress of the tendon.  So it is like many other conditions, like plantar fasciitis, that onset as a result of repetitive stress.  In my case there was no sudden “pop” or sharp pain.  I was just doing some running one night in late December on a treadmill and the area on the inside lower left ankle became sore.  The soreness became worse as I tried to continue to run for the next few days.  The pain became more intense and it spread all the way to beneath my big toe.  At this time, in the middle of January, I began to think I had a significant injury and I sought the help of an orthopedic surgeon.

The FHL tendon does three functions for us.  It flexes the big toe, elevates the arch, and assists with pointing the toes away from the body.  It attaches at two points, beneath the distal phalanx, or the end bone of the big toe, and runs along beneath your arch and over your inner ankle bone to insert into the FHL muscle about five inches above your ankle.  The FHL muscle is the most powerful of the deep muscles of your lower leg.

After my x-ray and MRI examinations were completed, my doctor identified tears to the flexor hallucis longus tendon, along with the adjacent posterior tibialis tendon.  There was a great deal of fluid present in the area around the two tendons and my Achilles tendon.  As a result, he had to wait for the excess fluid to dissipate before he could administer a cortisone injection.  He advised me at the time that my condition was found more commonly in ballet dancers.  It has even been called, “dancer’s tendonitis.”  It results from repetitive push-off movements of the forefoot while dancing or running.

Since I am a severe over-pronator, I am more prone to incur this type of injury because the constant inward rolling motion of my feet puts more stress on my arches than for those fortunate enough to have a neutral running stance.  So a quick yell out to the rest of you over-pronators out there, those super-cool vibram toe shoes are not for you.  Even with the use of an orthotic it is possible to suffer an injury to the FHL tendon or the posterior tibialis tendon.  Make sure that the orthotic you do use also has a posted heel.

Healing and Recovery

In the meantime, about twelve weeks, I had to stop all running and limit my workouts to a stationary bike.  I also used the R.I.C.E. (Rest, Ice, Compress, Elevate) rehabilitation regime in order to bring down the inflammation and speed the healing of the tears.  This injury was the most frustrating running injury I have ever suffered.  I could walk daily with almost no pain, but trying to run for only a span of thirty seconds would bring the pain level up to excruciating.  Any activity that would require an impact of my left foot on any surface would bring an instant pain reminder that all was not well.

Many of us are often tempted to try to reduce our recommended rehab time in these kinds of cases.  Do this at the risk of making your condition a chronic and lifelong source of pain.  Be very conservative and follow your doctor’s orders.

Finally, on my birthday, the levels of fluid had reduced enough for me to get the cortisone shot.  Then it was another two-week ban from running before I could resume any regular training. 

Resuming Training

Once you resume running it is best to start from the beginning with runs on a treadmill or some other softer surface.  Limit your time to ten to fifteen minutes. As long as you are not feeling any pain you can then add time at the rate of about ten percent per week.  So I am now back on the treadmill and back to running along the Hudson River with my dog, Brooke.  I am up to one hour now and looking forward to running a marathon this fall.

Good luck to the rest of you and I hope to see you someday on the Saturday morning NY Flyers group run that I co-lead with Scott S, or on some other occasion.

Jim S