The Great Toe

When you think of the most common lower body injuries, you think ankle sprains, shin splints, runner’s knee, jumper’s knee, fasciitis, or Achilles tendinitis. When you have these injuries, you treat the injured area. We might be overlooking a little, but big deal.  Dysfunction in the big toe influences every step you take, every lunge, every jump, and every stride of every run. Ultimately, it can be a direct result in many of the aforementioned common lower body injuries. If you have dysfunction (pain, instability, or hypomobility) at the first big toe joint (MTP joint), it could wreak havoc on the entire kinetic chain.

Normal range of motion of the big toe is 40° flexion, 80-90° extension, and 10-20° abduction and adduction. Lack of motion, especially extension, will create compensatory movement at other joints. Common big toe issues such as, hallux valgus (bunion), hallux rigidus, turf toe, sesamoiditis, and gout will limit toe mobility. Below is an image of a client who demonstrates normal range or motion on the right and limited toe extension on the left.

N ROM   Limited ROM

Much like limitations in ankle dorsiflexion, decreased big toe extension will lead to altered kinematics to the proximal joints (foot, ankle, knee and hip). The body is excellent at finding the path of least resistance will find ways to compensate for limited toe extension. The image below demonstrates normal gait pattern on the uninjured (right) during toe-off. During toe-off on the left we observe forefoot supination, subtalar inversion, calcaneal outflare, tibial internal rotation, knee adduction, and hip internal rotation all due to abnormal toe extension. This is how we compensate. These compensatory movements are risk factors for our most common lower extremity injuries.

Altered gait

If your client is suffering from lower extremity such as ankle sprains, shin splints, runner’s knee, jumper’s knee, fasciitis, or Achilles tendinitis evaluate mobility of the big toe. If limited motion exists, especially for toe extension, your treatment plan should focus on improving toe mobility. The following treatment techniques will help improve 1st MTP joint mobility:

  • Positional Release Technique to the abductor / flexor hallucis muscles (see image below) will help release soft tissue restrictions.
  • Instrument-Assisted Soft Tissue Mobilization (IASTM) to flexor and abductor hallucis tendons as well as the plantar 1st MTP joint tissue will break up adhesions.
  • Dorsal and plantar joint mobilizations (see image below) release intra-joint restrictions.
  • Daily passive stretching will aid in elongating tissue and normalizing collagen formation.
Dorsal and plantar joint mobilization of the 1st MTP joint.

Dorsal and plantar joint mobilization of the 1st MTP joint.

Positional Release of the Abductor Hallucis

Positional Release of the Abductor Hallucis

 

 

 

 

 

 

Remember, the problem doesn’t always exist where the pain resides. Don’t ignore the big toe. Identifying  and correcting dysfunction at the big toe can go a long way in resolving lower leg injuries.

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