Trigger Toe/FHL Tenosynovitis
My big toe 'clicks' and gets 'caught' sometimes. I have to use my hands to release it."
Trigger toe occurs most commonly in female classical ballet dancers. It results when the flexor hallucis longus (FHL) tendon on the inside of the ankle moves irregularly through its anatomical pulley mechanism around the ankle. Sometimes, the tendon actually locks distal to the tendon canal (near the big toe) and prohibits a dancer from using the strength in her big toe when en pointe.
Trigger toe can be the result of inflammation or a partial rupture of the FHL tendon, accompanied by swelling along the sheath in which it’s contained. The tendon may become frayed and scarred down, adhering to the sheath and creating friction, inhibiting its smooth gliding motion. The condition may present as non-painful and annoying for a period of time before becoming painful. Pain is typically noticed as a dancer lowers from demi-pointe to flat.
Early identification of trigger toe can assist in its recovery. Dancers should use ice, particularly ice massage as a way to decrease local inflammation.
A Podiatrist consult is helpful to assist with soft tissue management of scarring or adhesions along the tendon. The dancer should take the time to perform slow, gentle stretching of the great toe prior to dancing.
More significant cases may require surgery to release the ligamentous portion of the FHL sheath and repair the tendon.
BOOK an assessment with our podiatrist who will provide treatment and identify and correct any underlying biomechanical issues and muscle imbalances and assist with rehabilitation.