A Previously Unreported Etiology of Trigger Toe

Abstract

Trigger toe is a rare entity, with only a few cases reported in the literature. It is usually seen in ballet dancers as a result of compression of the flexor hallucis longus tendon in the tarsal tunnel beneath the medial malleolus. We report a case of trigger toe due to a constricting lesion on the extensor hallucis longus tendon.

Idiopathic hallux saltans an unusual presentation of flexor hallucis longus tendinopathy: a case report

“…FHL tenosynovitis is a rare condition, more prevalent among a special subset of patients like ballet dancers or athletes who perform repetitive plantarflexion movements (3) . They usually respond to conservative treatments such as NSAIDs, corticosteroid infiltration, and physiotherapy (5) .…”

“…Its main function is flexion of the hallux metatarsophalangeal and interphalangeal joints (2) . This infrequent pathology has commonly been related to sports that require excessive plantar flexion, such as classical ballet dancers, soccer, downhill runners, and gymnasts, between the second and fourth decades of life (1,3) . The typically described locations for FHL entrapment are the re-tromalleolar FHL sheath (most frequent), within the fibroosseous tunnel below the sustentaculum tali, at Henry's master knot, and behind the intersesamoid ligament (2) .…”

“…Although considered an idiopathic condition, some authors have implied a relationship between FHL entrapments to Os Trigonum, an osteochondral structure created by a secondary chondral ossification center at the level of the posterior margin of the talus and Stieda process (3) . Other less common causes may be space-occupying cystic formations, accessory flexor digitorum longus, calcaneal fractures, ankle arthrodesis, and tumors such as chondromas within the tendon sheath and lipochondromatosis (3,4) . Symptoms are similar to its analog in hand: a preserved flexion movement with a sudden release during extension caused by the thickened tendon (trigger effect).…”

“…Symptoms are similar to its analog in hand: a preserved flexion movement with a sudden release during extension caused by the thickened tendon (trigger effect). However, the degree of movement restriction could vary from a simple snapping to a joint blocked in flexion that needs a manual extension to release deformity, with variable associated retromalleolar pain (3) .…”

Posterior Ankle Arthroscopy for Flexor Hallucis Longus Entrapment: A Case Report

“…Trigger finger is mainly caused by the inflammation in the flexor tendon sheath and thickening of the pulleys [ 6 , 7 ]. Regarding the toes, although stenosing tenosynovitis of the FHL has already been reported in a few cases, the clinical condition is rare [ 7 , 8 ]. It is recognized as hallux saltans, and most cases are observed among sports players, especially ballet dancers [ 4 , 9 ].…”