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Trigger Toe – Symptoms, Causes, Treatment & Prognosis

Reviewed by
Dr. Kelsey Armstrong

Trigger toe is an injury that most commonly affects ballet dancers, due to the physical demands of dancing en pointe, a position that requires a dancer to stand on her or his toes, placing all body weight on the big toe (the hallux).

Inflammation of the flexor hallucis longus (FHL) tendon caused by this stress makes it difficult or impossible to flex the big toe.

What Are The Symptoms of Trigger Toe?

Trigger toe symptoms are usually mild at first, and the affected individual may experience only mild discomfort.

If the sufferer is a ballet dancer, however, he or she will eventually find it difficult or impossible to dance en pointe, and will experience especially sharp pain when lowering the foot from pointe position to a flat position.

The toe may lock up, and the individual may find it necessary to use his or her hands to manipulate the toe until it can be moved or flexed. The affected person may also experience a “clicking” sensation when trying to move the toe, or a feeling like the toe is “caught.”

What Causes Trigger Toe?

The flexor hallucis longus muscle runs down the leg, through the calf and ankle, along the bottom (plantar) side of the foot—becoming a tendon along the way—and ending at the big toe.

The conditions that result in trigger toe occur when the FHL tendon begins to move in an irregular way through the pulley mechanism that guides it through the ankle.

When the FHL becomes inflamed or swollen, it may not fit properly into the sheath of tissue that surrounds and supports it (a partial rupture of the tendon may also cause this).

As the condition worsens, the FHL tendon may become frayed or scarred, which can cause it to adhere to the tissue sheath around it. The resulting friction prevents the FHL from gliding smoothly back and forth, resulting in trigger toe.

What Are The Risk Factors for Trigger Toe?

The primary risk for trigger toe is ballet dancing—specifically the en pointe or demi-pointe positions. Trigger toe is rare outside the profession of dancing.

Are There Complications of Trigger Toe?

If trigger toe is not diagnosed and treated properly (and in some cases even if it is), it can mean the end of a dancer’s career.

How Is Trigger Toe Treated?

If you believe you are experiencing symptoms of trigger toe, you should make an appointment to see a podiatrist as soon as possible because early diagnosis may improve your chances of recovery.

Conservative treatment may begin with rest, ice, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce the inflammation.

Your doctor may also recommend physical therapy. If you continue to dance while undergoing treatment for trigger toe, you will probably be advised to perform slow, careful stretches of your big toe and the ball of your foot prior to rehearsing or performing.

If your case is severe, surgery may be necessary to release the ligament portion of the FHL sheath, after which the tendon can be repaired.

How Can I Prevent Trigger Toe?

Most people will never need to worry about preventing trigger toe, as the condition is rare outside the world of professional ballet.

For dancers, unfortunately, there is little that can be done; trigger toe is simply one of the many dangers of ballet dancing. You can minimize your risk of trigger toe by making sure to warm up thoroughly before each rehearsal or performance.

What Is The Prognosis For Trigger Toe?

With treatment, trigger toe can be overcome, and it may be possible for a dancer to resume his or her career.

Medical References:

    The National Institutes of Health Wikipedia The Harkness Center for Dance Injuries/NYU Langone Medical Center

This page was last updated on October 2nd, 2015

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