It was an incredibly interesting day yesterday; I observed a multidisciplinary review, for a runner with persistent calf pain. He was suffering pain and cramping on running and had already endured two operations do decompress the Flexor Hallucis Longus (FHL) tendon in the left ankle. FHL helps us press the big toe down on the back foot, when we toe off during walking and running.
After a case history review and examination, it was suggested that a distension tenogram under X-ray fluoroscopic guidance, would be appropriate. Apparently a rarely performed procedure, so I was lucky to see it.
Tendons connect muscle to bone and the tendons run through lubricated sheaths so that they can glide easily when the muscle contracts. When adhesions develop between the tendon and sheath, movement is restricted and it can be very painful.
The procedure involves injecting liquid between tendon and the sheath, causing the sheath to balloon and break the adhesions; The surgeon likened it to when you blow down the wrapper of an ice lolly, to stop the paper sticking to the frozen treat!
The long thin dark liquid looking area on the left of the picture is where the fluid has expanded the tendon sheath and broken the adhesions. We watched the fluid track up and the tendon sheath as the adhesions were released. Fascinating.
Using a functional osteopathic approach, then next step is to understand why the FHL tendon became compressed in the first instance. Then we aim to restore normal foot and ankle function, to allow them to get running again and achieve their 2014 fitness goals.