The big toe, or Hallux to its friends, is one of my favourite parts of the body. This rather strange looking piece of anatomy, which is bolted onto our extremities and often forgotten about, is in fact a crucial power house when it comes to movement. With every step we take this joint (the metatarsal phalangeal joint) must be able to bend between 45 and 60 degrees to enable us to ‘toe off’ as we step forward.
As you are reading this see if you can lift yours up off the floor as the ball of the big toe stays grounded. Do they rise equally? As you lift them up can you see the arch under your foot start to pick up and your shin start to rotate outwards? If the answer is yes pat yourself on the back, if no then we have some work to do!
This is not an uncommon asymmetry to find in clinic, which if discovered early can be treated with some osteopathy joint manipulation and Anatomy in Motion movement drills, however if left unchecked can lead to a host of clever compensations through out the body including the dreaded bunion. Three of the most common ‘cheats’ I see to enable the body to remain 100% functional are achieved by by-passing the big toe. Try standing up and taking the right leg behind you as if we were walking forward. As your weight moves forward the big toe has to bend and this is where the problem starts. Out comes the road map and the brain looks for a detour.
Ingenious compensation number one:
Turn left.
Instead of bending the big toe the foot turns out and pivots over the inside edge of the big toe. For a short time this seems like a good strategy, but unfortunately with every step we take the big toe starts to adapt to the stresses and strains placed upon it and we develop a bunion or a condition called halux valgus (a big toe that ends up pointing towards the other toes at an angle). The other problem I often see is that as the bony rigidity of the foot is compromised we end up pushing off from the soft tissue under the foot instead. The result ‘plantar fasciitis’ or strain to the connective tissue under the foot which feels like walking on broken glass. Neither conditions ideal when wanting to slip on a pair of sling backs (so I’ve been told).
Ingenious compensation two:
Turn right.
This is less common, but the body can prevent pressure through the big toe by inverting the ankle (think inversion sprain), lifting the big toe off the floor and pushing off from the outside of the foot instead. This can lead to an interesting wear pattern along the outside of your running shoes, a tendency to repeatedly sprain the outside of your ankle and discomfort along your iliotibial band as the body uses this instead of the hip flexors to whip the leg forward into swing phase.
Ingenious compensation number three:
If you can not go round, and going under is not an option then the only other way is to go over.
By shortening your stride length and lifting the leg up early, the big toe does not have to bend so much. Apart from always walking in circles (actually the body manages to compensate further up the chain-it is always going to be successful!) this will result in a shortening of the hip flexors and inhibition of the core and buttock muscles, which can reek havoc around the body in terms of back pain, hip pain and even head aches. In fact the whole process becomes more metabolically taxing, as the leg is dragged forward instead of relying on the elastic recoil of the fascial system. We want movement to be pain free and effortless with a spring in your step as opposed to walking around with one concrete boot on.
If you are experiencing toe pain, a bunion, plantar fasciitis, knee pain, hip pain, back pain…….(the list is endless) start by taking a look down at our ostracised friend the big toe. He is nicknamed the ‘great toe’ for a reason and you may just be surprised about how powerful he really is.