{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T14:59:25Z","timestamp":1777042765298,"version":"3.51.4"},"reference-count":13,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPMA"],"abstract":"<jats:p>Flexor hallucis longus (FHL) tendon injuries, although rare, severely affect foot stability and mobility, particularly in individuals engaging in repetitive push-off actions. This case study examines a 27-year-old male who underwent surgical repair for FHL tendon rupture, followed by a structured, multi-modal rehabilitation program integrating advanced therapeutic techniques. The 12-week program was divided into three distinct phases to ensure a structured and progressive recovery process. The Early Phase (Weeks 1\u20134) focused on pain and edema control through interventions such as massage, electrotherapy, kinesiotaping, and the use of peritendinous ultrasonography to monitor recovery progress. The Intermediate Phase (Weeks 5\u20138) aimed to enhance strength and flexibility by incorporating Proprioceptive Neuromuscular Facilitation (PNF), weight-bearing exercises, dynamic stretching, and the progressive integration of Graston massage techniques. Finally, the Advanced Phase (Weeks 9\u201312) prioritized functional recovery, utilizing balance training, load transfer exercises, agility drills, and Theragun applications to prepare the individual for a return to optimal physical performance. Significant improvements were observed, including pain reduction (VAS score reduced by X%), increased dorsiflexion flexibility (from X\u00b0 to X\u00b0), and enhanced muscle strength (e.g., tibialis anterior strength increased by X%). Functional assessments, such as the Y Balance Test, revealed improved endurance and mobility. This case study highlights the benefits of integrating innovative techniques like Graston massage and Theragun within a structured, evidence-based rehabilitation program to optimize recovery post-FHL tendon surgery.<\/jats:p>","DOI":"10.3390\/japma116030027","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T12:29:11Z","timestamp":1777033751000},"page":"27","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Structured Multi-Modal Rehabilitation Program for FHL Tendinitis and Os Trigonum Excision: A Case Report"],"prefix":"10.3390","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5763-6008","authenticated-orcid":false,"given":"Ba\u015far","family":"\u00d6zt\u00fcrk","sequence":"first","affiliation":[{"name":"Physiotherapy and Rehabilitation Department, Faculty of Health Sciences, Fenerbahce University, Istanbul 34758, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Beyza Ba\u015fer","family":"\u00d6zt\u00fcrk","sequence":"additional","affiliation":[{"name":"Feneryolu Physiotherapy Clinic, Feneryolu Mahallesi Ba\u011fdat Caddesi, Istanbul 34758, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"ref_1","first-page":"6236302","article-title":"Posterior arthroscopic treatment of a massive effusion in the flexor hallucis longus tendon sheath associated with stenosing tenosynovitis and os trigonum","volume":"2020","author":"Tonogai","year":"2020","journal-title":"Case Rep. Orthop."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"109934","DOI":"10.1016\/j.ijscr.2024.109934","article-title":"Flexor hallucis longus impingement syndrome: A case report","volume":"109","author":"Oesman","year":"2024","journal-title":"Int. J. Surg. Case Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.cpm.2020.12.011","article-title":"Os Trigonum Syndrome","volume":"38","author":"McAlister","year":"2021","journal-title":"Clin. Podiatr. Med. Surg."},{"key":"ref_4","first-page":"325","article-title":"Good Results for Treatment of Flexor Hallucis Longus (Stenosing) Tenosynovitis: A Systematic Review","volume":"2","author":"Opdam","year":"2017","journal-title":"J. ISAKOS Jt. Disord. Orthop. Sports Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1016\/j.csm.2020.06.001","article-title":"Posterior ankle impingement and flexor hallucis longus pathology","volume":"39","author":"Sharpe","year":"2020","journal-title":"Clin. Sports Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Sar\u0131alio\u011flu, N. (2024). Acute Effects of Myofascial Release on Foot Mobility and Performance in Basketball Players with Hypomobile Feet-A Randomized Controlled Trial. Life, 14.","DOI":"10.3390\/life14111404"},{"key":"ref_7","first-page":"690","article-title":"The Acute Effects of a Percussive Massage Treatment with a Hypervolt Device on Plantar Flexor Muscles\u2019 Range of Motion and Performance","volume":"19","author":"Konrad","year":"2020","journal-title":"J. Sports Sci. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e39619","DOI":"10.1016\/j.heliyon.2024.e39619","article-title":"The effect of percussion and manual activation massage on explosive strength and balance in young adult males: A crossover pilot study","volume":"10","author":"Pacholek","year":"2024","journal-title":"Heliyon"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"253","DOI":"10.11152\/mu-3519","article-title":"Peritendinous effusion of the flexor hallucis longus tendon as a sign of ankle joint capsule injury","volume":"24","author":"Hung","year":"2022","journal-title":"Med. Ultrason."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"101704","DOI":"10.1016\/j.foot.2020.101704","article-title":"Functional outcome of gastrocnemius advancement flap augmented with short flexor hallucis longus tendon transfer in chronic Achilles tear","volume":"45","author":"Jain","year":"2020","journal-title":"Foot"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100009","DOI":"10.1016\/j.fastrc.2021.100009","article-title":"Surgical repair of a ruptured flexor hallucis longus tendon via tenoplasty and autogenous peroneus longus tendon graft","volume":"1","author":"Edwards","year":"2021","journal-title":"Foot Ankle Surg. Tech. Rep. Cases"},{"key":"ref_12","first-page":"4857","article-title":"Flexor hallucis longus tendon reconstruction with M. plantaris graft\u2014A case description and rehab program","volume":"29","author":"Kateva","year":"2023","journal-title":"J. IMAB Ann. Proc. Sci. Pap."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1256","DOI":"10.1053\/j.jfas.2018.03.041","article-title":"Reconstruction of neglected flexor hallucis longus tendon rupture: A case report","volume":"57","author":"Anastasopoulos","year":"2018","journal-title":"J. Foot Ankle Surg."}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/3\/27\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T13:13:42Z","timestamp":1777036422000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/3\/27"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":13,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["japma116030027"],"URL":"https:\/\/doi.org\/10.3390\/japma116030027","relation":{},"ISSN":["1930-8264"],"issn-type":[{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]}}}