Our big toe (Hallux), in my opinion is one of the most underrated joints of the human body, for me it is up there with the knee joint and is essential for us to partake with ease in all our daily activities; by absorbing and producing force to aid us in locomotion, playing a vital role for our balance and proprioception. (Ask anyone you may know who has lost a big toe and they will certainly tell you how difficult it is to walk and balance).
Let’s talk briefly about the functional anatomy of the Big Toe:
So we all know it as the “Big toe” which is the toe most closest to the midline of the body. (Always check your second toe when purchasing shoes as this can be bigger; known as a Morton’s foot type)
Functions of the big toe: - Stabilise the arch and foot during mid-stance of walking or running - Produce force during the toe off stage. (Known as the windlass mechanism)
The big toe is able to take loads of 40-60% of a person’s bodyweight during the stance phase and is responsible for 80-85% of the stability within the foot!
Type of joint: The big toe has two joints; these being the Metatarsal Phalangeal Joint (MTPJ) which is the most important and the interphalangeal joint which is between the two phalanxes.
Beneath this MTPJ there are also 2 pea shaped bones which act as a pulley for the tendons, allowing the big toe to move normally and allow for leverage during toe off stages of locomotion.
The MTP Joint is a Synovial, condyloid, and biaxial joint; this allows for the following types of movement:
· Flexion (Plantarflexion) using the following muscles: - Flexor hallucis longus - Flexor Hallucis brevis - Adductor Hallucis
· Extension (Dorsiflexion) using the following muscles: - Extensor hallucis longus - Extensor hallucis brevis
· Abduction using the following muscles: - Abductor Hallucis
· Adduction using the following muscles: - Adductor Hallucis
· Circumduction using the following muscles: - Achieved through all the muscles mentioned above ^
These movements at the MTPJ allow for the big toe direct our body weight in the direction we would like to walk, run, jog, hop etc! The more force and range of motion we have with the big toe; allows for greater function, decreased injury risks and improved performance!
The big toe also plays a massive role in our balance and proprioception; we have thousands of nerve endings within the big toe which allow us to feel, move and regulate every little thing and this informs the brain as to how and where our feet are situated at a given time. The foot also acts as a tripod with the heel, 5th MTPJ and 1st MTPJ being the three points, the big toe helps control and stabilise this tripod as much as 80-90% as we move.
Big toe function can be limited from the following: - Restricting footwear. - Ingrown toenails of big toes. - Weakness of intrinsic foot muscles. - Previous Trauma. - Genetics.
Some features of a well-functioning big toe: - Ability to dorsiflex (Point upward) at an angle of 65 degrees. - Produce a peak force of approx. 10% of one’s body weight. - Ability to press the big toe into the ground while lifting the lesser toes off the ground and vice versa.
How we can achieve these functions: - Doing exercises barefoot. - Specific toe muscle exercises. - Walking and playing barefoot. - Using your big toe as much as possible.
Common Problems we see occur to the big toe:
- Hallux Abducto Valgus (Bunions)
- Hallux Limitus and Rigidus
- Turf Toe
- Sesamoid Injuries
- Hallux Fracture
- Stubbed on furniture.
Take home message:
Big toe function is extremely important to aid in performance of all activities, reduce injury risk and help us balance. Essentially, if we do not use it we lose it. So give the big toe the time of day and play around with it, move it as much as possible and try not to restrict it!