We continue with the fourth video in our sports massage of the foot, this time visiting the one of the deep intrinsic toe flexors: flexor digitorum brevis.

The flexor digitorum brevis is a broad muscle that has three origins: the medial process of the calcaneal tuberosity, intermuscular septum, and plantar aponeurosis. It attaches proximally to the tuberosity of the calcaneus and distally by separate tendons, to the middle phalanx of each of the four lesser toes.

This supports the arch of the foot and manages flexion for all toes except the great toe. It helps propel the body forwards during normal walking.

Pain and tenderness are projected from trigger points in the flexor digitorum brevis to the sole over the heads of the second to fourth metatarsal bones with occasional extension over the head of the fifth metatarsal . The referred pain does not extend back as far as the centre of the sole, nor forward onto the toes. The bony portion of the plantar forefoot can be sore and tender, leading to the complaint of sore foot symptoms.

For assessment, use passive extension of the second, third, and fourth toe applied at the middle phalanx. If it is painfully limited, the flexor digitorum brevis may be shortened by trigger points.

For further confirmation, you can ask the patient to press down hard against the examining finger. This can test for significant weakness. Palpation of the painful areas establishes whether these areas also exhibit tenderness that may be referred from trigger points. Since chronic trigger point tension in a muscle induces tenderness at the attachment site, patients with trigger points in the intrinsic flexors of the toes are likely to be tender in front of the calcaneus where the plantar aponeurosis attaches.

Note that this sometimes mimics plantar fasciitis symptoms.

Keep in mind when palpating the flexor digitorum brevis it lies deep to the thick plantar aponeurosis so you need sufficient pressure to engage the trigger points.

Part 1:    • Extensor digitorum brevis and extenso...  
Part 2:    • Abductor hallucis | Sports massage fo...  
Part 3:    • Abductor digiti minimi | Sports massa...  
Part 4:    • Flexor digitorum brevis | Sports mass...  
Part 5:    • Adductor hallucis | Sports massage fo...  
Part 6:    • Quadratus plantae | Sports massage fo...  

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These videos are intended to be used for information purposes only and are not intended to be used for medical diagnosis or treatment or to substitute for medical diagnosis and/or treatment rendered or prescribed by a physician or trained healthcare professional. This information is designed as educational material and should not be taken as a recommendation for the treatment of any particular person or patient. Always consult your physician if you think you need treatment or if you feel unwell.