Over the past two or so months, the number of people I have met who can’t get into a plank, perform a walking lunge or split squat (among other positions) because they can’t bend their toes back far enough has really astounded me. I am sure I have met people over the years that also have this restriction, but the prevalence of it these past few months has borne this blog post.
At first thought, it seems only minor that someone’s big toes do not dorsiflex (lift up/extend) enough to create a 90º angle (or something relatively close to that angle) at the metatarsophalangeal (MTP) joint (big toe connection to your foot–1st metatarsal). In reality, this is a huge dysfunction. The literature is not super specific as to exact ranges, but we need somewhere between 50-90º, with some literature saying 65-75º for good walking mechanics and close to 90º for good running mechanics. If dorsiflexion of your big toe is limited, this can alter walking mechanics and create a bunch of other aches, pains and common ailments and injuries.
Because the human body is good at compensating to complete tasks, AKA living, you may have limited dorsiflexion and not even know it. SO, if you didn’t just take a few moments to try a few of the above listed positions or to pull your big toes into dorsiflexion, then please do so now.
It is good to know if your big toes have enough dorsiflexion, because as stated above, if you do not have a sufficient amount of dorsiflexion (generally about 65-75º), your walking mechanics will be altered, setting you up for more possibilities of various injuries. And if you are a person who jogs/runs with insufficient dorsiflexion, this creates a higher potential of various injuries because the nature of jogging/running is such that it creates way more force that walking.
Some Common Ailments
- Excessive Supination. Limited dorsiflexion in the big toe may lead to rolling the foot inward, towards the other toes (2nd, 3rd and maybe 4th toe) during the push-off phase of walking bringing your foot into a more supinated position, leading to:
- Ankle Spains, especially in inversion (rolling out)
- Generally instability and lack of balance (the ‘rolled in’ foot position decreases your ability to use the plantar fascia for its main purpose, which is foot stability; this is called the Windlass Mechanism).
- Potential stress fractures in the other metatarsals or toe bones due to increased load and sheer force.
- Knee and hip pain due to increased in internal rotation of the leg through the push off (propulsion) phase of walking.
- Excessive Abduction of the foot or duck foot. This turned out position can domino into other ailments including:
- Bunions (another name for arthritis in your 1st metatarsal), because you are now turned out and rolling off the medial side of your 1st metatarsal.
- Knee pain because now your knee is no longer extending along the line that the knee flexes and extends, causing excessive wear on the knee joint.
- Hip discomfort from the external rotators (e.g., gluteus maximus, piriformis, and biceps femoris) of the leg being overly activated.
- Inability to attain triple extension, the full extension of the ankle, knee, and hip, this reduces the force production or power of your stride–the ability to push you forward. This may not seem super important unless you are a jogger/runner, but it’s also needed if you want to power walk somewhere. (here’s an interesting article on triple extension including athletes that aren’t runners)
- Decreased ability to add force and create more speed in runs or sprints, jumping, squatting, etc.
- Common ailments: runners knee and jumpers knee
The above photo shows a foot were the right big toe has sufficient dorsiflexion, close to 90º, while the left big toe has insufficient dorsiflexion. Below is a photo of that same person and how the leg movements change because of the limited dorsiflexion.
- Other common ailments due to compensatory patterns are:
- shin splints
- plantar fasciitis
- over-pronation or the falling of your arches
- achilles tendinitis
- pain in hips or pelvis, low back and even up to your shoulders and neck, because your connection to the ground is now altered and we have to take up the alteration in our bodies to ensure we stay upright and moving.
This is a video from one of the articles I read and found really fascinating and I hope you do, too. It’s analyzing two different runners and their big toe dorsiflexion. It’s truly amazing. All of this applies to walking, too, though with less force on our bodies.
What to Do if Your Big Toe(s) Are Limited
If you noticed that you seem to have limited dorsiflexion in your big toe(s), you can check to see if it’s a muscular limitation or if it might be something else. Come to all fours, hands under shoulders and knees under hips, and turn your toes under, bringing them into as much dorsiflexion as possible. MAKE SURE YOU ARE NOT ROLLING OUT TOWARDS THE SMALLER TOES. If you feel a stretch in your plantar fascia, then you may just need to stretch and/or roll the bottom of your foot with a lacrosse ball. Although it might still be a good idea to have your foot mechanics checked out by a Physical Therapists or Podiatrist to make sure all is well.
If, however you feel discomfort in the metatarsophalangeal (MTP) joint, especially on the closing angle (top side of your foot), then it would be best to see a podiatrist or another medical foot specialist. The limitation could be something simple that could be remedied with some basic treatments or it could be something more severe like bone spurs, Hallux rigidus or other arthritis.
What I hope to convey is that if you can’t turn those toes under to do a plank or a walking lunge, this is not a thing to blow off as no big deal. This is something that could be contributing to other aches and pains in your life or potentially cause some significant injuries and I want to keep you all safe and healthy, or as safe and as healthy as possible.
Please feel free to reach out via a comment or an email if you have any questions.
Reading and References