Big Toe Impeding Your Progress

By Sohaila Mosaddegh, DPT

Physical Therapy and Sports Medicine Center

More Heart Disease, Stroke and Diabetes Articles

Big Toe Impeding Your Progress

Most of us don't realize how much stress we put on our big toe. Every step we take places a force equal to about twice our body weight on this toe.

The joint where the big toe and foot meet – the first metatarsophalangel joint – bends and allow our foot to roll forward and push off when we walk. For us to walk normally, this joint needs to be able to bend back 65 degrees. As twice the size of the same joint in our other toes, this joint is the major player in accepting body weight as we push off of the foot. In addition to its increased size, this joint also takes loads better than our other toes because of small bones called sesamoid bones. These bones provide shock absorption and, more importantly, serve an important role with the muscles of the foot and their ability to control and propel the foot.

The first metatarsophalangel joint (the big toe) is a small joint, but osteoarthritis makes this joint stiff and difficult to bend (a condition called halluxrigidus).

This makes simple activities like walking, running, squatting, and bending over excruciating.

Research is not clear as to why some of us develop halluxrigidus and others do not. Congenital defects, poor foot mechanics, trauma (fractures and sprains), and sports injuries are some factors leading to these degenerative problems. Ballet dancing, gymnastics, and sports with quick changes in direction on artificial surfaces (“turf toe”) are common types of sports that cause stress to this joint. Rheumatoid arthritis and the metabolic disorder of gout can also lead to degeneration in this joint as well.

Signs and Symptoms

If you don't seek early treatment, degeneration of the joint may become more severe and may affect the joint's ability to move effectively. Therefore, it is important to recognize the signs and symptoms of this condition and take appropriate action.

Pain walking and with activities where the toe bends backwards.

Swelling and redness in the joint where the big toe meets the foot.

Pain and stiffness that is aggravated by cold, damp weather.

Tendency to walk on the outside of your foot or with a shortened stride without pushing off the toes, which progresses to a painful limp as degeneration of the joint becomes more severe.

Pain in other locations such as the ankle, knee, hip, or low back as your body attempts to adapt to bearing your weight as you walk.

Controlling your pain and inflammation is the first step in treating this condition.

Your clinician will often recommend rest, ice, and anti-inflammatory medication such as ibuprofen to decrease swelling and inflammation.

Cold and hot contrast baths may be used to help improve circulation in the area. In addition, physical therapy can improve your mobility, walking mechanics, and pain level.

Physical therapy can improve the ability of the big toe to bend up and down as you walk. Joint mobilizations and traction to the toe can make movement more comfortable.

Soft tissue release and massage may help restore mobility of the muscles and decrease local inflammation.

With an increase in mobility, gait training is needed to re-teach your body to walk correctly. The longer you have walked improperly, the more conscious effort and time it takes to resume your old way of walking.

Physical therapy treatment includes assessment of the whole lower part of the body to check for changes in gait mechanics. Abnormal gait from big toe pain can result in weakness and loss of motion in the hip, and ankle.

Orthotics

Custom made orthotics/shoe inserts may be recommended as well.