What is a trigger toe?

Trigger toe is the name for when the toe (normally the first toe in ballet) gets stuck in flexion and needs releasing manually, often accmpnaied with a clunking sensation. It is most common in female ballet dancers.

Why does it happen?

The catching is due to the tendon of FHL as it passes around the inside of the ankle. If the tendon becomes damaged over time it can become course and thickened, there may even be the presence of micro tears and some swelling. This thickening causes a catching sensation in the normal glide of the tendon in its sheath and under the retinacula keeping the tendons in place.

The space behind the medial malleolus (inside ankle bone) houses the tendon of FHL, FDL and tib post, along with nerves and vessels. It is a relatively small area when the foot is pointed and so unforgiving if there is any swelling or thickening of the tendons.

The FHL tendon can become thickened over time from incorrect use of the big toe, commonly seen with clawing. FHL is also under extra strain from feet that pronate excessively in standing and with jumps as it has a role in supporting the arch.

Symptoms and Treatment

It is not necessarily painful at first , and is often felt with a clicking sound and catching feeling usually on lowering from demi to flat.

The tendon can be thickened to palpate and will often have a crackle feeling to it when the toes are moved with a pointed foot. This is often tested by your physio as part of the assessment.

Treatment will comprise of releases into the muscle of FHL, FDL and tib post. Icing may be useful, especially if there is swelling around the tendon.

It is them imperative to look into technique to understand why the muscles are ‘unhappy’. Training will need to be commenced with the smaller intrinsic muscles of the foot to stabilise the arch and lessen the load on the extrinsic muscles.

If the thickening and nodules are quite bad surgery may be required to exise the nodule and smoothen the tendon to enable it to glide.

Recovery from surgery will need to be overseen by your dance physio.

Trigger toe can also be seen in other toes and result from a muscle imbalance which causes the ligaments and tendons to become unnaturally tight. The toe has a hooked appearance and may be rigid (unable to straighten) or flexible (able to straighten but returns to hooked position). It is common to find calluses or blisters on the top of the toes where they rub onto shoes .Trigger toe found in the other toes is more commonly seen with feet that have high arches ( pes cavus)

A tailored exercise programme to mobilise and improve the function of the intrinsic foot muscles (small muscles in the foot which control the toe movements) can prove very effective in this case also.