When a patient walks in with a primary compliant of foot pain a lower body screening is necessary. This means watching the patient walk normally, walk on toes, walk on heels, squat, single leg squat, and other sport specific movements. Many times the hip can be the culprit for causing foot pain, but not always. If hip strength and range of motion is within normal limits, it is time to start looking from the bottom up. One area that is often forgotten or overlooked is the Big Toe.

What is the Big Toe?

The big toe (great toe) is also called the Hallux. The base of each toe is the metatarsal and the actual toes are called phalanges. The big toe is made up of 2 phalanges: a proximal and distal one. The motions of the big toe include: flexion (move the toe down), extension (lift the toe up) and abduction (move the toe out to side).

What Is Most Important About the Big Toe?

How Much Big Toe Extension Do We Need?

How To Test for Big Toe Extension

Testing for big toe extension can be done several ways. It’s important to test both sides to see if there are any differences. If one big toe is more stiff than the other it can through of a person’s gait pattern. The following two tests can be used at home to test your big toe extension:

1. Seated big toe extension stretch
   •  Sitting with leg extended use finger to pull big toe into extension
2. Big toe stretch at stair
   • Put toes at the crease of the stairs
   • Keeping base of toes down on the top of the step, lean forward
   • Normal: base of toe should stay on the step  and the toe should be able to extend to almost flat against the next step
   • Compare tightness and toe position side to side

Final Thoughts

Exercises for Big Toe Mobility and Strength:

• Put toes at the crease of the stairs
• Keeping base of toes down lean forward until a stretch is felt in the toe and arch of foot
• Hold 3x 15-20 second hold

• Seated with feet flat and hairband or rubber band around big toes
• Separate feet so the hairband is taut
• Keeping the foot down lift just the toes
• Repeat for 10 repetitions

• Standing with feet together
• On one side go all the way up on toes with pressure being between the 1st and 2nd toe
• As you begin lowering, start to go up on toes on the opposite side
• Alternate this movement from side to side for 10 repetitions

• Keeping feet flat on the ground
• Lift just the big toe keeping toes 2-5 on the ground
• Then switch and keep the big toe down and lift only toes 2-5
• Alternate for 10 repetitions