Flexor Hallucis Longus (FHL) & Flexor Digitorum Longus (FDL)

This course describes the anatomy and integrated function of the flexor hallucis longus and flexor digitorum longus muscles (a.k.a. hallucis longus and digitorum longus muscles, flexor hallucis and digitorum muscles, FHL and FDL muscles). These muscles are likely composed primarily of type II fibers (based on the composition of the peroneus longus, hallucis brevis, and digitorum brevis muscles). They are located deep to the soleus in the posterior compartment of the lower leg, the flexor hallucis longus tendon, and flexor digitorum longus tendon course behind the medial malleolus, through the tarsal tunnel, and invest into the plantar surfaces of the toes. These muscles cross and contribute to ankle (talocrural) plantar flexion and inversion, transverse tarsal joint flexion and supination, the FHL contributes to great toe flexion, and the FDL to metatarsophalangeal joint flexion of toes 2-5. This course also describes the role of the FHL and FDL in ankle and foot arthrokinematics, fascial integration, postural dysfunction, and subsystem integration. Sports medicine professionals (personal trainers, fitness instructors, physical therapists, massage therapists, chiropractors, occupational therapists, athletic trainers, etc.) must be aware of these deep compartment muscles of the lower leg and foot for detailed analysis of human movement, and the development of sophisticated exercise programs and therapeutic (rehabilitation) interventions. Further, this course is essential knowledge for future courses discussing injury prevention and physical rehabilitation including tendinopathy (a.k.a. hallucis longus tendon inflammation, flexor hallucis longus tendonitis, FHL tendon dysfunction, FHL & FDL tendonitis, etc.), as well as foot ankle dysfunctions (e.g. posterior ankle pain, hallux rigidus, tarsal tunnel syndrome, plantar nerve pain, plantar fasciitis, Achille’s tendonitis, shin splints, etc.) and FHL and FDL exercises and techniques (e.g. long toe flexor muscle or plantar flexor muscle release, mobilizations, lengthening and integration techniques).

Pre-approved credits for:

• Human Movement Specialist (HMS) Certification

Pre-approved for Continuing Education Credits for:

• Athletic Trainers
• Chiropractors
• Group Exercise Instructors
• Massage Therapists
• Occupational Therapists - Intermediate
• Personal Trainers
• Physical Therapists
• Physical Therapy Assistants
• Physiotherapists
• Yoga Instructors

This Course Includes:

• AI Tutor
• Text and Illustrations
• Audio Voice-over
• Research Review
• Technique Videos
• Practice Exam
• Pre-approved Final Exam

Brookbush Institute’s most recommended techniques for the Toe Flexors (see videos below):

• Release: Calf Complex Static Release
• Manual Release: Flexor Hallucis Longus & Flexor Digitorum Longus Static Manual Release
• Manual Manipulation: Talonavicular and Cuneonavicular Joint Manipulation
• Lengthening: Slant Board Calf Stretch

Caption: Cadaver Disscection of the Flexor Hallucis Longus and Flexor Digitorum Longus

1. Phillip Page, Clare Frank, Robert Lardner, Assessment and Treatment of Muscle Imbalance: The Janda Approach © 2010 Benchmark Physical Therapy, Inc., Clare C. Frank, and Robert Lardner
2. Dr. Mike Clark & Scott Lucette, “NASM Essentials of Corrective Exercise Training” © 2011 Lippincott Williams & Wilkins
3. Donald A. Neumann, “Kinesiology of the Musculoskeletal System: Foundations of Rehabilitation – 2nd Edition” © 2012 Mosby, Inc.
4. Michael A. Clark, Scott C. Lucett, NASM Essentials of Personal Training: 4th Edition, © 2011 Lippincott Williams and Wilkins
5. Leon Chaitow, Muscle Energy Techniques: Third Edition, © Elsevier 2007
6. Tom Myers, Anatomy Trains: Second Edition. © Elsevier Limited 2009
7. Shirley A Sahrmann, Diagnoses and Treatment of Movement Impairment Syndromes, © 2002 Mosby Inc.
8. David G. Simons, Janet Travell, Lois S. Simons, Travell & Simmons’ Myofascial Pain and Dysfunction, The Trigger Point Manual, Volume 1. Upper Half of Body: Second Edition,© 1999 Williams and Wilkens
9. Cynthia C. Norkin, D. Joyce White, Measurement of Joint Motion: A Guide to Goniometry – Third Edition. © 2003 by F.A. Davis Company
10. Cynthia C. Norkin, Pamela K. Levangie, Joint Structure and Function: A Comprehensive Analysis: Fifth Edition © 2011 F.A. Davis Company
11. Florence Peterson Kendall, Elizabeth Kendall McCreary, Patricia Geise Provance, Mary McIntyre Rodgers, William Anthony Romani, Muscles: Testing and Function with Posture and Pain: Fifth Edition © 2005 Lippincott Williams & Wilkins
12. Brent Brookbush, Fitness or Fiction: The Truth About Diet and Exercise © 2011 Brent Brookbush - http://www.amazon.com/Fitness-Fiction-Truth-About-Exercise/dp/0615503012
13. Carolyn Richardson, Paul Hodges, Julie Hides. Therapeutic Exercise for Lumbo Pelvic Stabilization – A Motor Control Approach for the Treatment and Prevention of Low Back Pain: 2nd Edition (c) Elsevier Limited, 2004
14. Andrew Biel, Trail Guide to the Human Body: 4th Edition, © 2010
15. Frank, RM, Hsu AR, Gross CE, Walton DM, Lee S. (2013). Open and arthroscopic surgical anatomy of the ankle. Anatomy Research International. 1-9.
16. Edama M, Kubo M, Onishi M, et al. (2016). Anatomical study of toe flexion by flexor halluces longus. Annals of Anatomy. 204: 80-85.
17. Mao H, Shi Z, Wapner KL, et al. (2015). Anatomical study for flexor halluces longus tendon transfer in treatment of Achilles tendinopathy. Surg Radiol Anat. 37:639-647.
18. Lui TH. (2012). Flexor Digitorum Longus Tendoscopy. The Journal of Foot & Ankle Surgery. 51:690-692.
19. Precerutti M, Bonardi M, Ferrozzi G, Draghi F. (2014). Sonographic anatomy of the ankle. J. Ultrasound. 17: 79-87.