Big Toe Mobility: Is It Really That Important?

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).
There are seven muscles that attach directly to the great toe. Seven!  These all contribute to great toe mobility and stability.  These include:
1. Extensor Hallucis Longus- extends big toe
2. Extensor Hallucis Brevis- extends big toe
3. Abductor Hallucis- abducts big toe
6. Adductor Hallucis- aducts big toe
4. Flexor Hallucis Longus- flexes big toe
5. Flexor Hallucis brevis- flexes big toe
7. Peroneus longus – flexes big toe

What Is Most Important About the Big Toe?

Extension! Normal toe extension is particularly important for a normal gait cycle. Without extension the stability of the arch and plantar fascia can be greatly affected. Weakness and tightness of the big toe (especially extension) causes issues with walking, lunging, jumping, squatting and running.

How Much Big Toe Extension Do We Need?

→ 60 to 65 degrees for normal gait. That means at least 80-90 degrees in a natural stretch.
This amount of motion allows for proper foot position to help absorb and support weight-bearing loads. It also assists in propulsion of the foot. To summarize, the big toe is the “kickstand” of the lower extremity. When it doesn’t function well, the rest of the body can be affected. This results in poor movement patterns that can lead to injury and pain at the ankle, knee, hip, and spine.

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

Without the mobility and stability of the big toe we can’t fully push off during our gait cycle. This can lead to compensation patterns which sets you up for injury. To make sure you have enough big toe mobility and strength, try adding the following exercises into your daily routine.
And, while you are addressing your big toe, make sure you have enough Dorsiflexion to go along with it!

Exercises for Big Toe Mobility and Strength:


1. Big toe stretch at stair
  • 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

 


2. Toe Yoga with hairband
  • 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

             


3. Runner’s work in standing
  • 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

 


4. Big toe lift to Big toe flexion
  • 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

    

©2018 ALL BLOG CONTENT at duncansportspt.com by Abbey Campbell, DPT


ABOUT THE AUTHOR

Abbey Campbell, DPT is a physical therapist practicing in Lafayette, CO at Duncan Sports Therapy and Wellness. Abbey is a former collegiate athlete swimmer and a new mother. She uses a whole-body, movement-based approach to heal injury and pain. Abbey is passionate about preventative care and patient education to get her patients back to happy, healthy movement.


References:

https://www.jospt.org/doi/pdfplus/10.2519/jospt.1984.5.5.240

https://www.jospt.org/doi/pdf/10.2519/jospt.1987.8.7.357

2 Comments

  1. Marie Walton-Mahon on April 10, 2019 at 5:42 PM

    Fabulous thank you from Progressing Ballet Technique

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