• Natalie Ruffe, PT, DPT

Big Toe, Big Problems

Updated: Jun 18

I know that I am not alone in having increased my frequency in running over the last several weeks as gyms have closed down. If you have ever been into Physical Therapy, or take pride in self education with training, than you know how important hip mobility and strength are. A great deal of emphasis, including a few of our previous posts, are dedicated to the importance of proximal control. But have you ever considered what lies further down the kinetic chain…at the very end, the last joint and structure in the lower extremities? If not, it is time to take a look at the big toe, also known as the great toe or first digit.


The great toe is the largest of the toes, quite intuitively, but is only composed of two joints. A significant amount of muscle tendon and ligamentous structures pass along and insert at or near these two joints. As a result, the great toe provides a large source of stability and power to the kinetic chain. It helps to maintain the support of the arch through its connection with the plantar fascia and is also the last structure through which we push off during gait, for both walking and running. If there is a break down in mobility or stability at the great toe, than the following sequence begins to falter lending to compensation and possible injuries. Many times, plantar fasciitis, calf pain and strains, shin splints, and even stress fractures can relate back to great toe dysfunction. And as we all find ourselves running more frequently now, it becomes even more important to address.


The big toe only moves into flexion and extension, or bending and straightening. When we look at gait, the big toe moves into extension as the foot rolls onto the toes and pushes away from the ground. Normal extension range of motion for the big toe is considered to be approximately 65 degrees. If the big toe does not extend, or bend back this far, dysfunction ensues secondary to an altered gait cycle, i.e. an abbreviated stance phase, excessive pronation/supination, lack of power in push off…all of which again can be further compensated for up the chain causing further risk of injury.


While I don’t expect you to measure the mobility of the great toe by yourself, you can compare side to side to visualize if one toe may be tighter than the other, or you may even feel some pulling or tightening along the bottom of the foot or in the calf as you bend your big toe back. Regardless if you can tell whether or not your big toe is indeed actually tight, if you are experiencing any foot, calf, knee, hip, or even low back pain, there may be chance your first digit is contributing – indirectly or not. If you are diligent about the strength and mobility of your hips, than it may be time to take a look further down the chain. Listed below are a few great exercises and stretches to facilitate both the mobility and stability throughout the foot and great toe.


Mobility

  1. Foam roll calves – emphasis on the outside portion of the calf as this is where the muscle that bends the big toe runs.

  2. Calf stretches – drop heels off a curb, place toes up against a wall, move into runner’s stretch position against a wall.

  3. Lacrosse ball roll the bottom of the foot – in sitting or standing

  4. Great toe stretch – while stretching calf, places a towel or “prop” up under the big toe to bend it back while you are stretching the calf to increase.

  5. Great toe stretch 2 – in sitting with foot on opposite knee, stabilize by holding the arch of the foot and with opposite hand, bend toe backwards.

  6. Great toe distraction – Find the big toe joint where it meets your foot, hold on each side of the joint and gently separate (almost like trying to pop your fingers). You may even bend the toe back and forth while distracting.

  7. Soft tissue mobilization – great excuse to ask for a foot massage.

Stability

  1. Toe yoga – with feet flat on ground, raise just the big toe keeping other 4 digits on the ground. Place big toe on the ground and raise the other 4 toes at the same time.

  2. Towel scrunches/marble pick up – place towel or marbles on ground. Grip towel to scrunch for repetitions, or pick marbles up with toes and place to the side.

  3. Calf raises – both legs, single leg, squeezing a ball between your heels, resistance band around both ankles.

  4. TheraBand ankle drills – active range of motion against resistance all four directions: dorsiflexion, plantarflexion, inversion, eversion.

  5. Balance drills – static or dynamic; be creative and maintain arch height.

  6. And always work on hip stability!

 

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