Does flexor hallucis longus groove morphology have an effect on flexor hallucis longus tendon pathologies?

Foot Ankle Surg · Oct 04 2026 · Recent

Yeşilli ME, Tokgöz MA, Baymurat AC, Ergişi Y, Ataoğlu MB, Kanatlı U

Department of Orthopedics and Traumatology, Faculty of Medicine, Gazi University, Türkiye

Foot & Ankle

SUMMARY — THE REDUCTIONIn posterior ankle arthroscopy patients, FHL tendon degeneration was more common with deeper, U- or L-shaped grooves and less common with shallow grooves or wider opening angles, suggesting groove morphology influences tendon pathology.
Abstract, as published

BACKGROUND: Our main aim in the present study is to investigate the effect of flexor hallucis longus (FHL) tendon groove morphology on FHL tendon pathologies.

METHODS: Patients who underwent posterior ankle arthroscopy in our clinic between January 2002 and November 2021 were analyzed. FHL tendon degeneration levels via Arthroscopic video records and FHL groove morphologhy via T1 axial MR imagings were compared.

RESULTS: While FHL degeneration was more seen in U-type and L-type groove morphologies and groove types with increased depth. Less flexor hallucis longus degeneration was seen in bracket-type, grooves with increased opening angle and shallow grooves.

DISCUSSION: FHL tendon groove morphology may affect tendon pathologies. A correlation may exist between the morphological types and morphometric measurements of the groove and the arthroscopic grade of FHL degeneration. Greater groove depth may be associated with increased FHL degeneration, whereas a wider opening angle may have a protective effect against degeneration.

LEVEL OF EVIDENCE: Level III.

Featured in the 2026-10-18 issue.

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