Decreasing Big Toe Pain in Ballet Dancers: A Focus on FHL Tendonitis
- Veronica K
- Oct 22
- 7 min read
In the world of ballet, we expect our feet, ankles, and toes to perform miracles. As dancers, conditions such as tendonitis tend to appear rather often, especially in the foot and ankle joint.
We are often aware of the larger areas such as the Achilles tendon but forget that tendonitis can painfully appear in other tendons such as the flexor hallucis longus.
These things do not just appear after one or two times of improper technique or daily habits. They result from a cumulative effect of improper footwear, poor recovery, inadequate strengthening, insufficient stretching, and technique deficits.
As someone who has recently experienced flexor hallucis longus tendonitis in the big toe and worked with many dancers who have also gone through this discomfort, let’s look at the causes, the preventative actions you can take, and how my custom training plans work to alleviate this condition and restore proper ballet technique.
What is FHL Tendonitis: Signs and Symptoms
The flexor hallucis longus, often called the FHL, is the muscle that bends the big toe into a pointed position and assists during push off. In ballet, we rely heavily on the flexor muscles of the body, and the FHL tends to overcompensate to help us reach demi pointe or en pointe.
When this tendon becomes irritated, you may feel:
• Pain along the inside of the ankle, under the arch, or at the base of the big toe¹
• Pain that worsens when you press off the big toe, rise to relevé, or go into pointe work²
• A clicking, snapping, or catching sensation in the big toe²
• Swelling or tenderness behind the ankle bone or under the arch¹
• Stiffness when starting class or after rest¹
• A sticky or hesitant sensation in the big toe during roll through or tendu²
In class, dancers might feel a tugging under the big toe or inside ankle during relevé. You may notice that your big toe feels like it is gripping or doing too much of the work, especially when stabilizing or balancing.
During tendu or dégagé, you might feel the toe curling under instead of lengthening outward. If you jump, you may feel a sharp discomfort in the base of the big toe when pushing off or landing, which makes your roll through feel delayed or uneven.
If you notice any of these signs, it may indicate that your FHL tendon is taking over too much of the workload.
Why the FHL Gets Overused in Ballet
When you rise into relevé or pointe, the main muscles that should be doing the work are the gastrocnemius and soleus, along with the tibialis posterior, peroneus longus and brevis, and the intrinsic foot muscles that support the arch and big toe. These muscles should initiate the movement to lift the heel, stabilize the ankle, and control the rise.
In many dancers, however, the FHL takes over early. This can happen because the larger plantar flexors are underactivated or fatigued, the arch muscles are weak, or there are technique issues such as over-relevé.
What is Over-Relevé?
Many dancers believe that being in a higher demi pointe means better technique or stronger feet, but forcing a higher lift can actually shift the weight away from where it safely belongs. The anatomically correct and safe demi pointe should be centered directly over the ball of the foot, right at the head of the first metatarsal, where the weight is evenly distributed and the arch can stay active and supported.
When a dancer holds a midrange position between the ball of the foot and the joint of the big toe, known as the interphalangeal joint, the big toe stays slightly flexed instead of fully extended. This position is unsafe and not true to proper ballet technique. It places excessive strain on the flexor hallucis longus and the small joints in the front of the foot, leading to gripping, instability, and even tendon irritation over time.
The goal should always be to rise fully over the ball of the foot so that the big toe can extend naturally while the muscles of the calf, ankle, and arch remain lengthened, strong, and active. Once the muscles are properly trained and the dancer can maintain alignment through the whole foot, the full extension over the ball of the foot becomes both strong and safe.
Forcing height by pushing past this point or holding the middle range between the ball of the foot and the big toe joint does not build better technique—it increases the risk of injury and weakens the foundation of true ballet strength.
This is one of the most common contributors to chronic FHL strain.
Allowing the FHL to dominate the movement is harmful because it is a small muscle compared to the primary movers. It is not designed to lift and stabilize the entire body’s weight repeatedly during class. When it is forced to do so, the tendon experiences friction within its sheath behind the ankle and under the foot, leading to microtrauma and irritation over time¹²³.
When we are in full pointe in a properly fitted pointe shoe, the FHL is supported by the structure of the shoe. It can hold an isometric contraction while the box and shank help distribute load. But when you are in soft slippers or barefoot, staying in a mid-range position between demi pointe and full plantar flexion, the FHL remains under constant tension.
Without the support of a pointe shoe or the full end range of the joint, this position becomes risky for the tendon and the smaller foot and ankle joints.
The result is ongoing irritation, inflammation, and eventual tendon thickening. Over time, this leads to pain in the big toe joint, difficulty rising to relevé, and stiffness when pushing through the metatarsals.
Daily Care and Footwear Choices That Affect FHL Recovery
Another observation I have made among many dancers I work with is how everyday footwear choices prolong the healing process of FHL tendonitis. What you do during daily life matters just as much as what you do in class.
Wearing shoes without heel support such as flip flops, slip-on sandals, high heels, slip-on tennis shoes without backs, or soft house shoes with poor structure can make the FHL work harder. These shoes often allow the midfoot to collapse or flatten, which forces the smaller stabilizers like the FHL to grip more to keep the arch from completely giving way.
Even if you are doing all the right things in class, recovery, and cross-training, wearing unsupportive shoes for hours every day can keep the muscle in a shortened, irritated position. This can undo progress you make in your rehabilitation and prolong your healing timeline.
During the recovery phase, you need to choose shoes that support the entire foot and ankle, keeping the alignment neutral. I personally love Brooks tennis shoes for their stability and supportive structure, as well as slippers with backs that I purchase from Amazon.
However, there are hundreds of great options available that provide heel support and proper arch alignment. You just have to find one that works for you!
While these choices might feel like a compromise in style or convenience, it is a small sacrifice when you value your foot health and longevity as a dancer.
Supporting your feet properly during daily life directly translates into greater function, less pain, and stronger mechanics when you step into the studio.
Retraining Techniques and Recovery Framework
In my work with dancers recovering from FHL tendonitis, I focus on three main areas: retraining movement patterns, strengthening the right muscles, and improving recovery strategies.
1. Technique Retraining: We correct faulty mechanics by teaching the dancer to rise fully through the ball of the foot before extending through the big toe. The sequence should feel smooth from ground contact to ball to toe. Over time, this helps the big toe find proper extension rather than gripping.
2. Strengthening and Activation: We target the intrinsic foot muscles, ankle stabilizers, balance systems and core muscles to restore safe activation. Proper coordination between the gastrocnemius, soleus, tibialis posterior, and intrinsic foot muscles helps offload the FHL.
3. Recovery and Load Management: We gradually reintroduce load through progressive relevé work, eccentric calf raises, and controlled roll-throughs. Recovery phases typically last six to eight weeks depending on the severity. Jumping and fast directional changes are reintroduced last since these demand high eccentric control from the FHL.
This framework is also why I developed my Foot and Ankle Program on the Veronica K Platform. It is not designed to diagnose or treat medical conditions, but to help dancers avoid common injury patterns, restore better use of the foot and ankle musculature, and build stronger arches whether you are flat-footed, neutral, or high arched.
The program helps dancers develop core and turnout control that supports proper foot and ankle alignment while teaching recovery and self-care habits that prevent burnout from overuse. These routines are quick, easy to perform, and require no expensive equipment. You can learn more about this course here.
Prefer 1 on 1 Corrective Ballet Training?
If you are looking for a customized plan to address your specific concerns such as FHL tendonitis and big toe pain, let’s book a consult and start a private six to eight week training program designed to help you build a safer, stronger ballet body.
References
¹ Hamilton, W. G. (1982). Foot and ankle injuries in dancers. Clinics in Sports Medicine, 1(1), 143-173. https://pubmed.ncbi.nlm.nih.gov/7124454/
² Kadel, N. J. (2006). Foot and ankle injuries in dance. Physical Medicine and Rehabilitation Clinics of North America, 17(4), 813-826. https://pubmed.ncbi.nlm.nih.gov/17097484/
³ Steinberg, N., Adams, R., & Ben, D. (2017). Tendon pathology and flexibility in young dancers. Journal of Dance Medicine & Science, 21(1), 23-30. https://www.iadms.org/jdms
⁴ Shah, S., Liederbach, M., & Kremenic, I. (2012). Flexor hallucis longus tendinopathy in dancers: A clinical perspective. Journal of Dance Medicine & Science, 16(3), 114-122. https://www.iadms.org/jdms
Image by kjpargeter on Freepik
*This article includes Amazon Affiliate links. If you choose to make a purchase through these links, I may earn a small commission at no extra cost to you. Your support helps me dedicate time and effort to creating content that promotes happy and healthy dancing. Thank you so much for being a part of the Veronica K Platform!
Comments