The big toe is a very underestimated joint in providing us with the stability and strength for movement. I would be the first to tell you that I was ignorant to this for a very long time, even considering I know exactly what happens if you injure your big toe as I have broken mine before. It left me on crutches for several weeks and unable to walk or run correctly for months. It was not this however that led me to appreciate foot stability a lot more, it was more to do with my frustration at not being able to help some people with walking difficulty. Back in 2015 I started working with several tricky cases of people who had severe walking impairments from car accidents, disease, and spinal injury. Working closely with these clients several times per week our typical training was helping a lot but not providing the improvement I really wanted. I knew I was missing something and I could see that in every case there was huge problems at the feet, even though none of these people had pain at the feet. I have covered the role of Foot Stability before but today I want to share more insight into the big toe specifically for as you will soon see there is a correlation between big toe dysfunction and injury elsewhere in the body
How The Big Toe Creates Problems For Other Joints
For over 20 years I have dedicated our training to helping people recover from injury and health problems. I have also worked with many elite sporting athletes searching for improved performance. In both cases I was trying to improve the same thing which is to move more efficiently.
The most interesting thing I regularly find is the small number of foot related injuries in comparison to the other injuries. Yet when I complete our assessments, and especially with knee and hip related injuries, it is extremely common to find huge stability problems at the feet. The big toe in particular, being rigid and unable to lift. Most of the people we asses indicate they have no pain at the foot, ankle, or any problems with the big toe. When I went back and analyzed the results of these assessments the findings were compelling.
I found that in over 70% of people assessed for knee pain or hip pain there was significant foot instability and big toe dysfunction!
This information really begins to explain a great deal about how people easily compensates at other joints due to problems at the foot. And how any corrective exercise intervention may have limited success if the source of the problem, which in this case is the big toe and foot instability is not addressed. I decided I needed to see if these findings were consistent with other highly respected practitioners and more experienced people.
I started to read several books that talked a lot about the importance of the feet, (the 3 books below are great reading) and I also completed several courses both in person and online.
I also began training myself, testing various drills and exercises on my own body and with the other trainers to understand the information we had learned. In 2015 I started using a tool called the Sensa Mat which was a huge revelation in terms of our training with foot stability and was a instantly a massive success. More on this later.
During the time we were testing more people I started to see a very common trend emerge among ALL people that had lower limb or hip/back injuries, and it was dysfunction of the big toe. The big toe dysfunction I am referring to is where there is a lack of dorsiflexion, (lifting the big toe backwards to your shin). Over 95% of people we tested had NO PAIN at the big toe or had ever been diagnosed as even having anything wrong.
In all the books and the information that I read, the best explanation as to how this small joint creates massive problems was in the book “Movement” by Gray Cook.
How Does Your Toe Have Anything To Do With Pain In Your Knee Or Hip?
This is the first thing people think when I tell them to take their shoes and socks off so I can assess their toes and feet.
If you have never read or heard us talk about the joint by joint theory developed by Gray Cook and Mike Boyle you will quickly see why this is so important.
Every second joint in our body needs a completely different role to the joint above or below. Any time a joint loses either it’s stability or mobility the joint above or below is greatly affected and forced into compensation.
Now the one joint that has a significant bigger role than all of the others is the big toe. Do you remember how I said that if there is a problem at a particular joint like the hips it will compensate to the joints above at the lumbar spine and below at the knee?
In the case of the big toe it has no joint below to refer to, so it is forced to compensate only above. The big problem here is that when we walk or do anything standing this joint is the first thing to move and as it has to compensate due to rigidity and lack of movement it begins to set off a chain reaction to ALL of your other joints. It is now just a matter of time until you are in trouble.
Watch the video below to see examples of this.
I hope you are beginning to see the potential problems that can arise from something so simple as a lack of big toe mobility, and just how easily it can lead to a wide spread of problems not just at the foot but right up the kinetic chain and beyond.
Examples of this compensatory chain reaction in action is when we observe poor knee alignment in single leg stance that causes pain and injury to the knee. Strengthening of muscles around the knee is pointless for the knee is dragged into the poor alignment by the weak foot and stiff ankle compensating. Until the cause of the problem is addressed no treatment will respond effectively.
See the picture below.
How Does The Big Toe Lose Mobility In The First Place?
That is a great question and it can be due to several things, but without doubt the most obvious reason is footwear.
Most shoes place us in elevated heels and create short tight calves with rigid ankles and weaken our feet. High heels cause serious problems, as do flip flops (thongs as they are known in Australia) as they completely change our gait cycle and require “toe gripping” to keep them on while you walk. If we were to walk barefoot as nature intended you would find that our entire body would be so more robust and strong.
Other factors that contribute to the problem
•Lack of exercise & sitting too much
•Poor running form or training technique
•Fatigue
•Previous injury
Another great book I highly suggest to read is “Born To Run” by Christopher McDougall shows several examples of how footwear contributes to so many lower limb problems.
This is a story of a guy who loved running but suffered with chronic injuries for a long time even with all the latest shoes, rehabilitation and treatment modern science provides. He set about researching the secrets of a hidden tribe in the desert that ran barefoot for hundreds of miles and never had an injuries!
When running barefoot, over striding and heel striking are not an option you will do for very long. The impact is immense and produces jarring and instant pain right up your entire leg. A bit like removing the suspension from you car. The modern running shoe with all the extra cushioning allows people to run without changing this faulty movement and while it saves you in the short term, over the long term running with this faulty technique will only serve to put you in pain. Not always at the feet, but where the shock runs to which is the joints above in the leg.
At first I thought we could overcome this by training the weak feet using the sensa mat and staying barefoot all the time. And while this was a great start, and definitely helped, in some cases we needed much more, and paying close attention to the big toe was the key. But first I needed to learn more about the big toe and exactly what it does and how much movement it required.
Big Toe Anatomy & Function
The way the foot muscles and array of small joints is designed allows the big toe to plantar flex during extension phase of walking to enhance the load-bearing capacity of the first metatarsal, and to improve the mechanical leverage for the attached intrinsic muscles. It has been documented that the first ray is designed for 50-70 degrees of big toe extension during static evaluation.
As the foot transitions from mid stance into push-off, the toes begin to dorsiflex and the plantar fascia is activated. This activation of the plantar fascia upon big toe dorsiflexion is referred to as the “windlass mechanism” and is the second step in preparing the foot for propulsion.
Since power during propulsion is dependent upon the foot’s ability to become a rigid lever, ensuring proper big toe dorsiflexion during the gait is vital to achieving full foot supination.
When you understand that during gait, your entire body is moving over this single joint, the ability to dorsiflex, and subsequently raise the heel during single support phase while simultaneously supporting against the developing forces for forward motion is essential for normal, efficient walking.
If this mechanism fails, your body will be forced to compensate. When the big toe joint motion is disrupted enough to prevent stabilization of the foot you are now set up for problems up the entire chain.
A common postural problem seen with big toe dysfunction the gradual shift into a forward weight bearing position. This forward leaning position creates the recipe for a permanent change in how we move or simply hold ourselves up in an upright position. For the brain will begin to learn from repetition that this is the new way to move.
Our brain does not question if this is a mechanically advantageous or not, it will continue to compensate in order to move and execute the tasks at hand. This is why it is so important to always train with good technique and find ways to ensure you are adopting the most efficient method of movement. The key is not allowing compensatory patterns to become encoded into the nervous system as permanent movement patterns.
Common Problems Linked To Big Toe Dysfunction
One thing is for certain it is very difficult to correct a faulty gait pattern once dysfunction sets in. It is so much easier to be aware of the potential dangers of compensation and using exercises to enhance your ability to walk and run correctly BEFORE they are broken down.
Watch the video below for ideas on this.
Some of the most common compensations seen are instability in the midfoot, poor ankle mobility, and limited hip extension.
1.Limited proprioception in the midfoot usually leads to plantar fascitis or achilles strains.
2.Lack of ankle mobility is a very common problem we see with knee pain. When we walk we need at least 10 degrees of ankle dorsiflexion with maximum ankle dorsiflexion occurring during late mid-stance. Limited ankle mobility can lead to a chain reaction of compensations including midfoot pronation, knee hyper-extension and an early heel rise during gait.
3.Limited hip extension can lead to abduction compensation and produce the classic over pronated foot type and abducted stance position. The stride length shortens and reduces hip extension and glute activation. You can see how hip problems like piriformis syndrome that exhibit glute weakness and inhibition could be driven by problems at the big toe and feet! When the correct pathway of motion is blocked by the lack of big toe dorsiflexion, the person will produce an abducted foot in order to roll off the inside of the toe in order to allow for hip extension.
This compensation is most often related to the development of bunions.
But even worse than this, there is also a lot of research indicating big toe dysfunction is a predictor of ACL injuries in sports for it places the knee in the point of “no return”. The plant foot angle used with change of direction movements in sports is critical to get right for it provides the optimal base for braking and instantly changing to acceleration during the push-off movement. If the foot plant is correct, this split second movement is smooth and effortless. If not, the risk of ACL ruptures and various other knee and hip injuries is significantly increased.
A great quote that really sticks in my mind and really sums up the role of the foot is by Dr Emily Splichal.
“The ability to rapidly unlock and lock the foot is necessary for peak performance – especially in sports or movements that demand rapid change acceleration of change of direction”.
Below is a video where I discuss the foot plant and change of direction in great detail.
What Can You Do To Improve Your Big Toe Function?
Well the good news is there is many things you can do and they are actually fairly easy. One of the first things I suggest you do is get some toe spreaders!
I myself have been using them everyday for some time now and my feet feel amazing! Wearing them as often as I can at home for hours at a time, I quickly see my toes begin to develop better alignment and my foot muscles that had become a bit lazy working better than ever! You can get some of these by visiting the website Foot Collective.
You can also practice spreading your toes using your foot muscles. This is a great way to reprogram the stability at the feet and it is incredible how many people find this so difficult to do. Use your fingers to help you if need be sure you can easily spread your toes apart.
Big Toe Lifts
You could think of this as bicep curls for your toes. Stand with your feet pelvis width apart and pointing straight ahead with your weight in your heels.
Try to lift the big toe only without moving any other part of your body. I often see people try to move their hips to help out which again is another clue as to how the body will compensate and this is where hip problems are created. Make sure you lift your toe straight up and not let it veer sideways. One you can do this then practice lifting all the toes except the big toe! And if you can do that then practice lifting one toe at a time and placing it back down slowly.
You can see exactly how to do this and also several other exercises we use with feet in the video below.
Learn How To Move Correctly
Lastly I would incorporate training bare feet into your gym sessions if possible. Teaching your body how to correctly stabilize the feet in combination with the other joints and muscles in work will go a long way to preventing any compensation or dysfunction that may already exist. Using movements like lunges and single leg stance drills that demand full flexion and extension of the big toe are fantastic, as are any of the dynamic exercises that require full foot stability in order to maintain alignment of the kinetic chain.
Watch the video below where I show you four exercises that incorporate the foot and the hip together to improve walking.
I mentioned earlier in the article that I like to use a tool called the Sensa Mat. This is a rubber mat with hundreds of spikes in it to facilitate the nerves in your feet into working more effectively.
In a recent study conducted by the Oregon Research Institute (ORI), textured surface for the feet exercise has demonstrated an improvement in physical function and reduction in blood pressure to a greater extent than conventional walking in older adults. These are known as mechanoreceptors in the sole of the feet in the skin. These mechanoreceptors have a large impact on balance and postural control. As we age, we experience DECREASED information from foot sole skin input. One solution is to augment skin information with the intent of improving balance.
Mechanoreceptors are structures in the body that enable people to experience physical sensations. They feed tactile information to the brain so the brain can process it, providing information about objects in the environment people interact with, as well as vibrations in the air and other sources of physical sensation.
The sensa mat takes advantage of these mechanoreceptors and as a result it improves foot stability and function.
Check out the video below where I show you how I use this.
Do You Need More Help?
If you currently suffer with hip, knee, or back problems you will find our online programs are a great resource that take you through all of the assessments and corrective exercises to get you back to full strength and out of pain. All of these programs are downloadable videos that come with PDF instructions manuals.
Go to the ONLINE SHOP to find out more and get a copy.
Summary
I hope you have enjoyed this article about a joint not many of us give much thought to but when you consider just how much influence it has on how we move you can see how critical it is to make sure it moves correctly. If you are suffering with an injury in your lower limbs or hips I would take the time to really apply everything we have discussed here and try to improve your foot and big toe function. The effort is well worth it for I can tell you first hand how much better I move from completing many of the simple drills and exercises featured in this article, not to mention observing the incredible improvement of many complex cases who come to see us each week.
The big toe is everything to how you move!
About The Author
Nick Jack is owner of No Regrets Personal Training and has over 20 years’ experience as a qualified Personal Trainer, Level 2 Rehabilitation trainer, CHEK practitioner, and Level 2 Sports conditioning Coach. Based in Melbourne Australia he specializes in providing solutions to injury and health problems for people of all ages using the latest methods of assessing movement and corrective exercise.
References
•Barefoot Strong – By Dr Emily Splichal
•Whole Body Barefoot – By Katy Bowman
•Born To Run – Chris McDougal
•The Vital Glutes – By John Gibbons
•Movement – By Gray Cook
•Corrective Exercise Solutions – by Evan Osar
•Diagnosis & Treatment Of Movement Impairment Syndromes – By Shirley Sahrman
•Anatomy Trains – by Thomas Meyers