Background: Restricted excursion of the flexor hallucis longus (FHL) is associated with several clinical problems. An FHL excursion measurement device (EMD) was used to objectively assess differences between patients with clinically normal or tight FHL tendons. Methods: 188 patients (356 feet) were enrolled. The EMD measured maximum ankle dorsiflexion with the great toe in 15 degrees, 30 degrees, and 45 degrees of dorsiflexion. All had clinical assessment of FHL tightness by their provider independently of the EMD measurement. Results: Increased hallux DF always caused decreased ankle DF. Patients with clinically tight FHLs demonstrated decreased ankle DF compared to normal subjects at all hallux positions (p < 0.01). The EMD measurement was not sensitive enough for detection of FHL tightness in individuals. A clinically tight FHL was seen in almost 50% of feet. Conclusions: Tension in the FHL can limit ankle DF. Clinical tightness of the FHL is likely more common than currently recognized. (c) 2020 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.
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