Trigger toe in classical-ballet dancers

Classical ballet involves extreme physical demands on the body--in part, strains beyond the physiological limits. Balance on the tips of the toes en pointe means extreme plantar flexion of the ankle and first toe in the weight-bearing position. We have treated two cases of stenosing tendovaginitis of the flexor hallucis longus tendon. A 22-year-old male dancer had been suffering from pain on the postero-medial aspect of the ankle at weight bearing for 6 months, when bilateral locking of the great toe going from en pointe to the neutral position occurred. At operation a fusiform thickening of the tendon of the flexor hallucis longus was found. After partial excision of the tendon sheet and partial incision of the retinaculum the tendon moved freely in its groove. Six months postoperatively the patient was free of symptoms. The second case was a 17-year-old female professional dancer with unilateral trigger toe. A similar surgical procedure was performed and the symptoms disappeared. Once the condition is known, the diagnosis is easy. Surgical excision of stenosing structures is the treatment of choice.