The key learning outcomes from the Musculoskeletal Corrective Exercise Workshop are to not only develop an understanding of corrective exercise techniques, but to understand how the body moves.  This article describes the importance of the big toe and how it affects movement.

The big toe (or hallux) is integral in the propulsive phase of gait.  In fact it carries twice the load of the lesser toes. During running the force passed through the big toe joint can be increased by two to three times bodyweight.

During the stance and propulsion phase of the stride, the big toe is rapidly flexed and extended under high loads. Any factor that affects this motion will alter gait and therefore performance.  If there is a restriction in the range of extension of the first metatarsophalangeal (1st MTP – see figure 1) joint, expect to see compensations, movement dysfunction and possibly injury resulting.

Normal 1st MTP extension is 65-75° when non-weight bearing, and 30-45° when weight bearing in a single knee bend (see figure 2).  Figure 3 shows hallux limitus (reduced extension of the 1st MTP).

Figure 2. Normal 1st MTP range Figure 3. Reduced 1st MTP extension

Several years ago I worked with a hockey goal keeper with left big toe damage resulting in reduced 1st MTP extension from ball strikes.  Pain was more severe after sprint and interval training sessions.  Hallux limitus will cause an early toe off during running.  This can lead to increased use of the hip flexors during running.  With overuse of rectus femoris and tensor fascia latae as hip flexors this can result in a range of problems from ITB pain to sacroiliac joint pain.  TFL and rectus femoris both anteriorly rotate the ilium to unlock the sacroiliac joint.  The tone in his left TFL was very high.  He also had ITB pain and bouts of sacroiliac joint pain.  The cornerstone of his treatment plan involved big toe mobilisations prior to exercise.  He also performed myofascial release work on his TFL with a foam roller.  The area where TFL blended into the ITB was hyper-sensitive. He had slightly limited hip extension range which he used stretching techniques to improve.  Symptoms improved rapidly with these techniques and he returned to sport pain free.

In the same season I was working with a softball in-fielder who had damaged his right 1st MTP joint with an impact from a softball.  This athlete began to suffer from right shoulder/elbow pain and fatigue (his throwing arm) in the weeks following this injury.  His shoulder girdle and glenohumeral joint mechanics were reasonable.  Reduced throwing volume seemed to help, but this wasn’t a long term solution leading up to a competition season.  Assessment of the toe injury followed by mobilisation and stretching of the restricted big toe provided almost instant improvements in throwing speed and symptoms.  Force is generated from the ground up during throwing.  In a right handed throwing action, force is generated from the right big toe, through the lower body pelvis, from the trunk, then expressed in the shoulder and arm (Figure 4.).

Try throwing a ball without pushing off your big toe and you’ll get an understanding of how important the big toe is in throwing movements.  This injured athlete’s strategy for throwing the ball hard was to use the shoulder and arm to generate force as he had limitations in the lower body.  This lead to tissue overload and time on the bench.  To fix the throw we needed to fix the toe!