Trigger toe, formally known as stenosing tenosynovitis of the toe, is a condition where a toe, most commonly the big toe, catches or locks in a bent position. This occurs due to an issue with the tendon that helps the toe bend and straighten. While it can be bothersome, trigger toe is generally treatable.
What Happens in Trigger Toe
The mechanics of trigger toe involve the flexor tendons, rope-like structures connecting muscles to bones, and their surrounding sheaths. The flexor hallucis longus (FHL) tendon is primarily involved in the big toe. This tendon moves through a protective tunnel, or sheath, lined with a smooth membrane that allows it to glide effortlessly as the toe bends and straightens.
A series of fibrous bands, known as pulleys, hold the tendon close to the bone, ensuring efficient movement. In trigger toe, the tendon or its sheath becomes inflamed or thickened, or a small nodule may form on the tendon itself. This thickening or nodule impedes the smooth gliding of the tendon through its pulley system. When the affected part of the tendon tries to pass through the constricted pulley, it can get stuck. If left unaddressed, persistent inflammation can lead to scarring, further hindering the tendon’s ability to move freely.
Common Causes and Who is Affected
Trigger toe can develop from various factors, often stemming from mechanical stress on the toe’s tendons. Repetitive movements and overuse are frequent contributors, particularly in activities that involve constant pressure or flexing of the toes. This condition is common among dancers, especially those who perform en pointe, as this puts significant strain on the big toe.
Underlying medical conditions also increase susceptibility to trigger toe. People with diabetes or rheumatoid arthritis have a higher incidence of tenosynovitis. Direct trauma to the toe or foot may also contribute. It can affect individuals of any age, though women may be more prone to developing it.
Recognizing the Signs
Recognizing the signs of trigger toe involves noticing specific sensations and limitations in toe movement. Individuals may experience a clicking, catching, or locking sensation in the affected toe, particularly when attempting to bend or straighten it. This can range from mild discomfort to a more pronounced, painful snap.
Pain and tenderness at the base of the toe are common indicators, which can worsen with movement. Stiffness in the toe, especially in the morning or after periods of inactivity, is another frequent symptom. In some instances, the toe may become difficult to move or may require manual assistance to straighten it.
Diagnosis and Available Treatments
Diagnosing trigger toe typically involves a physical examination by a medical professional, who will assess the toe’s movement and tenderness. The doctor will observe the toe as it bends and straightens, looking for the characteristic clicking, catching, or locking. Patient history, including any repetitive activities or underlying medical conditions, is also an important part of the diagnostic process. Imaging tests, such as X-rays or MRI scans, are usually not necessary for diagnosis but may be used to rule out other conditions.
Treatment for trigger toe often begins with conservative approaches aimed at reducing inflammation and restoring smooth tendon movement. Rest, applying ice to the affected area, and taking nonsteroidal anti-inflammatory drugs (NSAIDs) can help alleviate pain and swelling. Activity modification, such as avoiding movements that aggravate the condition, is also advised. Splinting the toe, especially at night, can help keep it in a straightened position, allowing the tendon and sheath to rest. Physical therapy, including gentle stretches and exercises, may be recommended to improve flexibility and strengthen the toe muscles.
If conservative methods do not provide sufficient relief, a corticosteroid injection into the tendon sheath may be considered. This medication helps to reduce inflammation and swelling, often providing temporary or long-term relief from symptoms. In cases where trigger toe persists despite these non-surgical interventions, surgical release may be an option. The procedure, known as tenolysis or release, involves making a small incision to widen the constricted part of the tendon sheath, allowing the tendon to glide freely. Recovery from surgery typically involves a period of healing, with targeted stretches and limited activity for several weeks.