Author:  Dr. Elyse Dinan, DPT

For something as small as a toe, it can be shocking to realize how large of an impact your big toe can have on the rest of your body. Every step we take, our big toe helps us sense and feel the ground under us, and plays a critical role in how we push off one foot and onto the next. If we have limitations in how well our big toe can extend, as it does when we come up onto our tip toes, it can significantly alter how we walk. This can then cascade into a series of compensations that can impact knees, hips, low back, and even further up the body into your upper back, shoulders, and neck. 

Basics of Walking: 

To understand the importance of the big toe, we have to first understand some basic anatomy, as well as the gait cycle – aka how we walk. Our big toe is meant to extend backwards about 70 degrees, to almost become a right angle from the bottom of our foot. This motion can become limited in a number of ways, but the two major contributing factors for decreased big toe extension would be a poor joint position which reduces this motion, or tightness in the flexor muscles which curl the toe down into the ground. 

Changes in joint position that could reduce toe extension can occur in a number of ways and for a number of reasons, but would be best identified in a full assessment with a physical therapist who would be able to properly evaluate you. The big takeaway here should be that changes in your foot, such as a high or low arch, excessive pronation or supination, or changed mechanics such as pushing off the outside of your foot rather than the big toe, can contribute to changes in how the bones line up at the big toe. This can then reduce how much your big toe can move. These are things we can improve if appropriate interventions and exercises are used to address the root cause of this position. 

The second contributing factor would be tightness in the muscles that hold the toe in a flexed or curled down position. The important thing to understand however is that this muscle would be tight as a reaction to whatever position your foot is being held in, or the demands that are placed on the foot. This is to say it’s very uncommon that people are born with muscles that are just “too tight”, but rather, it’s much more likely that the muscles become “tight” as a reaction to the environment they are in. Therefore, just as above, it is critical to find the root cause that is leading to this tightness to be able to resolve it and find long term solutions. 

Gait Cycle: Push Off

To understand the importance of the big toe, we will be looking at the terminal stance to toe-off phases of gait outlined below. In this phase, our heel leaves the ground and we rock forward over the big toe. To be able to do this, as mentioned before, the big toe needs to be able to extend backwards. This is critical in allowing us to have normal mechanics and the ability to push ourselves forward. We take thousands of steps every day, so if these mechanics are impaired, it can have big impacts over time. 

Without appropriate toe extension, people will often roll to the pinky side of their foot to push off, or they will develop a bunion where they have rolled off the inside edge of their toe rather than it extending backwards at the joint itself. Either of these can lead to pain within the toe and foot itself, and can also increase stress and strain at the knees, hips, low back, and other body parts as they compensate to allow for smooth walking around this limitation. 

Regardless of if you are having specific foot pain, have pain elsewhere, or are concerned you may be developing a bunion, this small joint is an important piece of the puzzle for many who are struggling to get out of pain. If you have been focused on just the location of your pain and not having success, it may be time to look head to toe  – quite literally – to see what other factors may be at play. A thorough assessment from a physical therapist will take this into account to help build a clear picture of your body’s limitations, compensations, and how they are keeping you in pain.