Indicated in fibrosing tenosynovitis of FHL
Lateral decubitus position with medial aspect of ankle facing upward; the other knee flexed to move the opposite foot; a pillow between knees to improve patient comfort; 15 degree rotation of foot toward supine position by placing a folded towel under forefoot to lift lateral aspect of foot from the table; additional towel under knee for patient comfort
Palpation of tendon in retrotibial region with repeated flexion and extension of great, adjacent to posterior tibial artery.
Alternatively, skin entery mark - 1 cm posterior to posterior tibial artery and 1 cm above the upper border of calcaneus; orientation mark - one-third the way along sustentaculum tali; pass the needle closely deep to neurovascular bundle to reach tendon sheath
25G needle is used.
Contrast is mixed with bupivicaine 0.25% or lignocaine 0.5%
0.5–1.0 mL (2–4 mg) of dexamethasone may be used therapeutically
Skin may be anesthetized
Avoid nerve block
References:
Na JB et al. The Flexor Hallucis Longus: Tenographic Technique and Correlation of Imaging Findings with Surgery in 39 Ankles. Radiology 2005;236:974-982
