Showing posts with label great toe pain. Show all posts
Showing posts with label great toe pain. Show all posts

Dec 8, 2014

Movie Monday: A Clinical Pearl For Assessing Great Toe Mobility

Another Monday means another movie to be shared with all of you. This week's video is a clinical pearl to keep in mind when assessing great toe dorsiflexion/extension (whatever nomenclature you like for sagittal plane motion at the great toe). This is especially important when dealing with runners and running injuries due to the influence of the great toe  during gait. Specifically, the ability to extend the hip, achieve terminal stance and proper toe-off. This is another pearl that I learned from Jay Dicharry and his book, Anatomy for Runners/The Healthy Running course.


The major point of this video is that the position of the ankle can have an effect on motion at the toe. This is important to consider because at terminal stance/toe off the ankle is placed in dorsiflexion and the toe must also dorsiflex as well to allow for a proper "ankle rocker" mechanism to occur. Failing to check toe mobility in both positions could lead to an improper assessment. The big toe really can be a lynch-pin when it comes to movement so we want to ensure it can do what it is supposed to do. Have a great day!

Jun 1, 2014

5 Tips For Improving Great Toe Mobility and Stability

The foot on the right is far from ideal, but its great toe position is better


In my previous post I discussed the importance of the "big", "1st", "great" toe, or hallux. I finished that post with a promise to share some ideas and methods for enhancing the health of your foot/toes and here I am to make due on that.

In reality, some people may already be too far gone to see much benefit from conservative methods of treatment. Unfortunately, with enough abuse from faulty footwear, poor biomechanics, and overuse some feet may require surgery. That doesn't mean that you may not find a decrease in symptoms or pain from conservative methods and all avenues to avoid surgical procedures should be explored in my opinion.

Instead of giving tons of in-depth and intricate details on things that you can do for better foot/toe mobility and motor control I am going to give some simple and easy ideas and concepts that can have a huge impact.

1) Avoid Shoes With a Tapered or Narrow Toe Box

The toes should be the widest part of the foot. This is often a rarity for people of developed nations and many think it is normal. However, if you look at a young child or toddler's foot it is likely that their foot still holds this true form. If you look at most footwear you will find that the toe boxes are often very constraining and the widest part of the shoe is usually not at the toes. They often come to a very distinct point about where the second toe is. One thing that I recommend when picking out a pair of shoes is to perform the "shoe liner" test. This is where you remove the liner or insole of the shoe and place your foot on top of it. If your toes splay over the edges then it is likely that the shoe is too narrow for your foot. This is very important for the developing feet of children and I think this video by Dr. Ray McClanahan does a great job of explaining this.

2) Avoid Shoes With a Toe Spring Design

If you view a shoe from a side profile you will notice that many conventional shoes will have a design where the sole will curve upward near the toes. This places the toes into an extended position relative to the metatarsals when at rest. I believe this was originally designed to help the shoe have a "rocker" effect to help people with poor ankle mobility.

3) Avoid Shoes With an Excessively Elevated Heel, "Ramp", or Heel-Toe Drop Design.

I attribute this shoe design and our cultures disdain for squatting (excessive sitting in chairs) to be major contributors to the poor ankle mobility that plagues many people and athletes alike. These three design flaws are discussed indepthly by Dr. Ray once again and he does a great job discussing them in this other video of his. You can do all the joint mobilizations, stretching, and flexibility work in the world but if you keep yourself or your patients in crappy shoes then you are fighting a losing battle.


4) Ensure Adequate Ankle Dorsiflexion

One thing that I have noticed in many patients with issues in the toes is that they are often accompanied by issues at the ankle, especially regarding decreased ankle dorsiflexion. Chicken or the egg here? I'm not sure but if a person lacks the ability to achieve full ankle dorsiflexion then their toes may be at risk for taking an extra beating. What about if you lack toe mobility as well? Good Luck. Here is a video I made for a quick and easy way to check and see if you have enough ankle dorsiflexion.


5) Increase foot intrinsic muscle strength/motor control

It isn't advisable to dive in headfirst and make drastic changes to your footwear in one fell swoop and expect all to be well. Even if you aren't going to change your footwear choices it is still probably advisable to work on intrinsic muscle strength/control. Here is another video I made previously showing some easy ways to improve foot/toe strength and mobility.


If you are still struggling with issues in your feet, ankles, or further up the kinetic chain and these simple tips aren't enough to resolve them then you may possibly need additional manual therapy from an athletic trainer, physical therapist, physiotherapist, podiatrist or chiropractor. There is also the possibility that a conventional approach may not be enough for some issues.

Some issues may require more time or help from products like Correct Toes. An foot-toe orthosis like them requires a post all to themselves but I personally have used it on myself, my patients and in research with some surprising success and outcomes. One thing that I will say is that I like how that product versus the cheaper generic types that you can find at say Walgreens or CVS will actually fit in your shoes, has multiple sizes, and can be modified for your foot shape.


May 20, 2014

How Healthy is Your Big Toe?

Hallux Valgus is only good for suppressing appetite and skinny pumps

Proper motion, strength, and position of your toes is a concept that is often lost with conventional approaches to health care. The toes may be one of the most commonly disfigured series of joints in the body, especially the big toe. Dr. Perry Nickelston of Stop Chasing Pain refers the big toe as one of the key movement linchpins in the body. For those of you that are unaware of linchpins it is the key piece of a complex system which is vital for holding it all together.

In reality, the above pictured toes should not be as common as they are. Right away the thoughts stray to women who indulge themselves with high heeled or skinny footwear with narrow and tapered toe boxes for fashion. During medieval times the fashion was for men to wear long, narrow and pointy shoes (think like elves?) and cadaveric studies of people from this time show that these disfigurements were more common in men than women which is the exact opposite of modern times/studies.

These sandals are a little too small for this fellow.

A foot or more specifically your toes should ideally look a lot more similar to the above foot. In fact, there really should be a slight gap between your 1st and 2nd toes! Having a big toe that is straight and mobile is beneficial for many different activities. In fact, I would argue that it is probably important for all activities that involve bearing weight through the feet. I've also seen videos of indigenous cultures using their toes with great dexterity.

"Sign here please, sir."
Your big toe is essential for proper balance, running, walking and many athletic activities or exercises. Somewhere around 55-60% of your support should come from your big toe during running. It also helps with foot stability, and explosive propulsion during power movements such as squats or the deadlift. Many bodyweight exercises or yoga positions require a mobile and correctly positioned big toe as well. You should have three major points of contact to the ground through your feet for proper function: the big toe, the calcaneus, and the lateral aspect of the foot around the base of the 5th metatarsal.

I dare you to try barefoot pushups without adequate toe mobility. Ouch.
I'm sure there are many people out there that are looking down at their feet and are taking notice of a slight to severe hallux valgus angle, or currently suffer from conditions such as hallux rigidus or limitus. You may even be functioning quite well in your prospective sports or activities of daily living. However, I can guarantee that a few things are probably true for you. 1) You are compensating for your poor positioning and/or mobility. 2) Your performance is lacking and could only be improved with improvements made here. 3) Finally, there is a chance you may be part of the 15%ish of the population that presents with Morton's foot.


If this is the case your 2nd toe will be longer than your first toe. In this circumstance your second toe is now taking an excessive load compared to what it was designed for. This is genetics at play and is arguably a less evolved toe structure from when the big toe was opposable like a thumb similar that of other primates.

In conclusion, the big toe can have a big impact on your health, performance and movement all the way up and down the kinetic chain. Even if you are not an athlete proper big toe health will be paramount when you reach an older age. The elderly are at risk for falling which has very serious impacts on life quality and expectancy post falling. Proper position of the big toe increases stability by widening the base of support and proper mobility of the big toe gives greater proprioceptive input for better neuromuscular control. Both are critical concepts for everybody.

In my next blog post/videos I will be going over ways to promote increased toe mobility and position! Stay tuned for more...

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