Muscles
Flexor Digitorum Longus Trigger Points
Symptom Area: Leg, Ankle and Foot
Flexor Digitorum Longus Trigger Points are explored here through their location and referred pain pattern. Muscle knots is an everyday term used for tender muscular spots; myofascial pain describes pain involving muscle and its surrounding connective tissue. Flexes toes 2–5; assists plantarflexion and inversion.
Where you feel it
When the Flexor Digitorum Longus holds active trigger points, you usually notice it as first steps in the morning feel as if walking on nails, plantar lesser toe pain and plantar midfoot pain. Where the pain spreads: Plantar surface of toes and medial arch. What often sets it off: Running barefoot, intrinsic weakness, overpronation.
Overview
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.
Trigger point locations
Deep posterior lower leg.
Referred pain pattern
Plantar surface of toes and medial arch.
Palpation & testing
Palpate the muscle belly along its accessible course. Reproduction of the patient's familiar pain on palpation supports involvement.
Common causes
Running barefoot, intrinsic weakness, overpronation.
Self-care & clinical treatment
Foot intrinsic work, toe mobility. Clinically: needling.
Treatment protocol
For Flexor Digitorum Longus, the general protocol applies: sustained pressure release on the taut band, then stretch and active movement in the newly gained range.
Position and palpation: Palpate the muscle belly along its accessible course.
Regional precaution for clinicians: In the calf, ankle and foot the tibial nerve and posterior tibial vessels in the deep posterior compartment, the common peroneal nerve at the fibular neck and the plantar neurovascular bundle guide needle placement.
Primary Symptoms
Secondary Symptoms
Often confused with
These muscles cause the same primary symptoms, so they are checked together:
Related muscles in this region
References
- • Travell & Simons — Myofascial Pain and Dysfunction
- • 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
- • 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
- • Effectiveness of trigger point dry needling for multiple body regions: a systematic review — J Man Manip Ther 2015;23(5):276-93
- • 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
- • Physiologic effects of dry needling — Curr Pain Headache Rep 2013;17(8):348
- • 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
- • Myofascial trigger points then and now: a historical and scientific perspective — PM R 2015;7(7):746-61
- • Pertinent dry needling considerations for minimizing adverse effects — Int J Sports Phys Ther 2016;11(5):651-62
- • Adverse events associated with therapeutic dry needling — Int J Sports Phys Ther 2020;15(1):103-13
- • 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
- • Myofascial Pain and Dysfunction: The Trigger Point Manual (2nd ed.) — Williams & Wilkins, Baltimore
Medically reviewed by: Marco Aruffo — physiotherapist since 2006, specialised in myofascial pain · Last reviewed:
