So you may have heard of a trigger finger, but a trigger toe? It is classified based on the mobility of the joint. There are three types – flexible, semi-flexible and rigid. With a flexible trigger toe the joint has the ability to move, whereas when it is semi-rigid or rigid, the toe does not have the same ability to move. Movement is very limited or not present. Limited movement of the semi-rigid type can be very painful.
A trigger toe injury tends to most commonly affect ballet dancers. This is 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.
It results from a muscle imbalance which causes ligament and tendon tightness. They are often seen in patients with neuromuscular imbalance and highly arched feet. Arthritis can also lead to forefoot deformities which include trigger toes. Trigger toes can also be the result of biomechanical foot imbalance.
The conditions that result in trigger toe occur when a particular tendon begins to move in an irregular way through the pulley mechanism that guides it through the ankle. When the tendon 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 tendon may become frayed or scarred, which can cause it to adhere to the tissue sheath around it. The resulting friction prevents the tendon from gliding smoothly back and forth, resulting in trigger toe.
The restricted movement caused by a trigger toe can lead to increased vertical pressure on the first metatarsal (just under the big toe in the ball of the foot area), causing various symptoms including pain, sesamoiditis, corns and callouses.
In the case of the dancers, they 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.” Inflammation of the tendon caused by this stress makes it difficult or impossible to flex the big toe.
The primary risk factor for trigger toe is ballet dancing, specifically the en pointe or demi-pointe positions. Trigger toe is rare outside the profession of dancing.
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.
Treatment and Advice
-Consideration of footwear is very important. A deep toe box with soft leather uppers is ideal. With certain medical conditions customised shoes are often required.
-Use good fitting hose which is not restrictive.
-Certain types of felt padding can be used to reduce pressure loading.
-Applying an appropriate moisturising cream is often helpful.
-The use of silicones, which can be purchased pre-packed.
-Podiatrists can mould silicone rubber to individual toes, which is often very successful.
-Routine foot care to address corns and callouses.
-Specific foot care for episodes of bursitis, ulceration or infection associated with trigger toes.
-Orthotics are very effective for dealing with certain types of trigger toes. Once the biomechanical factors have been identified, the orthotics may be designed to provide motion control to elevate or support the first metatarsal. They can also straighten the flexible trigger toe to some degree and improve function.
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 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.
Most people will never need to worry about preventing trigger toe, because of the rarity of the condition 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 minimise your risk by making sure to warm up thoroughly before each rehearsal or performance.
With treatment, trigger toe can be overcome, and it may be possible for a dancer to resume his or her career.
Your feet mirror your general health . . . cherish them!