Bilateral hallux Saltans, a Rare Finding: Diagnosis and Arthroscopic Treatment in a Young Ballet Dancer: Report of a Case.

Abstract

Introduction: Hallux Saltans is an uncommon pathological entity mostly encountered in correlation with physical activities such as ballet dancing or football. It is a stenosing tenosynovitis of the flexor hallucis longus (FHL) tendon, relating to inflammation and fibrous metaplasia of the pulleys. This disorder can cause pain and hinder sport career progression.

Case report: A 16-year-old female, training to become a professional ballet dancer, presented with a 2-year history of pain and swelling of the right ankle, associated with triggering of the hallux and audible cracking at active extension.After a magnetic resonance imaging (MRI) diagnosis of tenosynovitis of right FHL tendon, the patient was treated operatively by posterior arthroscopic tenolysis of the FHL, which was entrapped by the fibrous tissue of the tendon sheath.During post-operative period, the patient presented an immediate relief from triggering of the hallux. She was able to start dancing again 6 weeks after surgery and her right hallux remained asymptomatic. However, about 8 months after surgery, she presented with the same triggering symptoms on the contralateral side.The pain, blocking, and triggering of her left hallux lead to an MRI investigation and once the diagnosis of tenosynovitis of the FHL was confirmed, an arthroscopic tenolysis was performed again. The treatment relieved the patient immediately.On follow-up, at 5 years after surgery on the right side and 4 years after left one, the patient remained asymptomatic on both sides. She keeps dancing, but stopped the professional career for personal reasons.

Conclusion: The condition known as trigger hallux is a rare yet debilitating pathology. When present, it should be taken seriously, and further radiological investigations should be performed to diagnose any potential tenosynovitis of the FHL. Arthroscopic release of FHL tendon sheath has proven to be a useful and minimally-invasive technique to approach hallux saltans pathology in a semi-professional young ballet dancer, enabling fast return to sport and long lasting results.