Muscle deep-dives
Flexor Digitorum Longus trigger points: referred pain, palpation and release
A clinical deep-dive on Flexor Digitorum Longus: trigger point locations, the referred pain pattern they produce, palpation landmarks, activating factors and an evidence-based release protocol.
Published:
Why this muscle causes pain
Flexes toes 2–5; assists plantarflexion and inversion. Trigger points here are common in everyday and athletic populations and frequently contribute to the referred pain patterns described below.
Where the trigger points sit
Deep posterior lower leg.
The referred pain pattern
Plantar surface of toes and medial arch.
How to find it by palpation
Palpate the muscle belly along its accessible course. Reproduction of the patient's familiar pain on palpation supports involvement.
What sets it off
Running barefoot, intrinsic weakness, overpronation.
Self-care that actually helps
Foot intrinsic work, toe mobility. Clinically: needling.
Symptoms this muscle produces
Clinically, this muscle turns up in the workup of first steps in the morning feel as if walking on nails, medial ankle pain, plantar lesser toe pain, plantar midfoot pain and posterior leg (calf) pain. Those are the complaints its referral zone overlaps, which is why a patient may present with any of them and never mention the muscle itself.
Muscles covered
Studies cited
Every claim in this article traces back to one of the sources below.
- Kietrys 2013 — Effectiveness of dry needling for upper-quarter myofascial pain: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2013;43(9):620-34 ↗
- Gattie 2017 — The effectiveness of trigger point dry needling for musculoskeletal conditions by physical therapists: a systematic review and meta-analysis. J Orthop Sports Phys Ther 2017;47(3):133-49 ↗
- Boyles 2015 — Effectiveness of trigger point dry needling for multiple body regions: a systematic review. J Man Manip Ther 2015;23(5):276-93 ↗
- Charles 2019 — A systematic review of manual therapy techniques, dry cupping and dry needling in the reduction of myofascial pain and myofascial trigger points. J Bodyw Mov Ther 2019;23(3):539-46 ↗
- Cagnie 2013 — Physiologic effects of dry needling. Curr Pain Headache Rep 2013;17(8):348 ↗
- Fernández-de-las-Peñas 2019 — Trigger point dry needling for the treatment of myofascial pain syndrome: current perspectives within a pain neuroscience paradigm. J Pain Res 2019;12:1899-911 ↗
- Shah 2015 — Myofascial trigger points then and now: a historical and scientific perspective. PM R 2015;7(7):746-61 ↗
- Halle 2016 — Pertinent dry needling considerations for minimizing adverse effects. Int J Sports Phys Ther 2016;11(5):651-62 ↗
- Boyce 2020 — Adverse events associated with therapeutic dry needling. Int J Sports Phys Ther 2020;15(1):103-13 ↗
- Hong 1994 — Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994;73(4):256-63 ↗
- Simons & Travell — Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.). Williams & Wilkins, Baltimore ↗
