Structured Multi-Modal Rehabilitation Program for FHL Tendinitis and Os Trigonum Excision: A Case Report

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 1–4) 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 5–8) 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 9–12) 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° to X°), 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.