24 Jun How To Rehab Big Toe Pain
Alright enough is enough, it’s time to stop dragging your feet in regards to taking care of that nagging big toe pain that you have been dealing with for months! Maybe you have tried a thousand pairs of shoes, spent your retirement fund on a new pair of orthotics, or have started paying the neighbor boy to walk Fido. Trust me, we get it, discomfort in your big toe joint can be very troublesome and feel very limiting, but guess what? You’re in luck as this is also a very treatable condition with the appropriate rehab program. Ready to get back on your feet? Let’s dive into how to rehab big toe pain…the right way with the best big toe exercises!
What Causes Big Toe Pain
Big toe pain can feel like a daunting condition to treat if we don’t fully understand why we are experiencing the pain so before we get after treating that big toe pain of yours, let’s talk about why the heck you are experiencing big toe pain. Maybe you have heard the term bunions tossed around or osteoarthritis, let’s dive into each of these a bit more. While these diagnoses can seem overwhelming, they are really just fancy terms for ‘hypomobility through the MTP joint’ meaning that your big toe just isn’t moving as well as we would like it too. Check out the picture below!
We hear the term bunion a lot, so what does it mean? A bunion is a result of the first metatarsophalangeal joint, or the big toe, drifting medially, or inward. Often times this is a result of degenerative changes over time, excessive use of improper shoe wear, and can also be hereditary in nature (1). It should be noted hallux valgus deformities were rarely noticed in Japan until after the introduction of Western- style footwear following World War II (1). Putting our feet into a shoe that has a narrow shoe box can over time, put unnecessary stress on the big toe and cause the big toe to drift inward. One of the biggest culprits of this improper footwear is high heels, time to drop the stalettos ladies!
Osteoarthritis or hallux rigidus is another common cause of big toe pain and discomfort. Osteoarthritis means that there is limited space in the joint that is often times associated with inflammation and a loss of cartilage in the joint space (2). Research shows that hallux rigidus is often found in those who have a family history of arthritis, those who have a history of trauma to the region, or those who are female (3). Now, it should be noted here that a diagnosis of hallux rigidus, or arthritis in the joint does not always correlate with high levels of pain. Recent studies show evidence of alterations in nerve processing of both the peripheral and central nervous system in regards to pain nerve sensitization but this varies greatly case to case and with severity of the arthritis within the joint (4).
Seasmoiditis is inflammation of a small set of two bones imbedded in the flexor hallucis brevis tendon (5). The role of these bones is to decrease friction of the tendon during movement, similar to how the knee cap operates (5). Pretty cool, huh? Bet’cha didn’t know you had two small “knee caps” on the bottom of your big toe! Often times, we see sesmoiditis with a turf toe type of injury due to repetitive strain and overuse of the flexor hallucis brevis muscle and repetitive impact (5) . Sesmoiditis is often overlooked in regards to a diagnosis for big toe pain but is very treatable. In the early stages of this injury, it’s important to follow the P.O.L.I.C.E Principle in regards to protecting the joint and loading it appropriately, appropriate progression from here is key to getting you back on the field.
Looking to Rehab Your Big Toe Pain in 3 Easy Steps?
While these diagnoses can seem overwhelming, they are really just fancy terms for ‘inflammation in the joint’ and ‘hypomobility’ meaning that your big toe just isn’t moving as well as we would like it too. Great news is, there are exercises that can help with this! One of the biggest things I try to educate my patients on is maintaining appropriate mobility in their feet. The foot is made up of 33 joints and ALL those joint needs to be working well to keep us on our feet.
If you have heard “surgery” mentioned in regards to dealing with your big toe pain I would strongly suggest trying conservative treatment first. Now, there is a time and place for surgical intervention, but in regards to the foot, once you alter one joint and how it moves, you alter them all and this can lead to further complications up the chain. Research has shown us that surgical intervention for a bunion can severely alter dorsiflexion of the foot, and this motion is crucial for normal gait mechanics, running, biking… you name it! Without appropriate dorsiflexion we can start experiencing knee pain, hip pain, and even back pain (2). Make us a promise right now and try some of these conservative exercises first, we think you will like them!
Improve Your Big Toe and Ankle Dorsiflexion Mobility With Our Program!
In order to optimize foot and ankle mobility, you also have to optimize big toe mobility! Specifically, adequate extension of the big toe is vitally important for pushing off through our foot as we begin the gait cycle. To learn more about our ankle dorsiflexion program, click HERE!
Best Big Toe Exercises
Big Toe Joint Mobilization
- HOW: In a seated position, cross the involved leg and foot over the other leg’s knee with your ankle hanging unsupported. Grab your foot around the ball of your foot stabilizing the whole foot with that hand. With the other hand, gently pull your big toe straight out as you move it up and down for the prescribed amount of reps.
- FEEL: You should feel a gentle stretch in your big toe joint.
- COMPENSATION: Don’t move your foot, focus the movement only in your big toe.
This is one of the tougher big toe exercises! Persistance is key! This is also a great exercise to perform on your invovled foot, but also your unionvlved foot as well as it’s great to improve mobility through all of your toes. Why not show both feet a little TLC?
Big Toe Exercises – Liftoff Seated
This is another one that will seem hard, and it should if you are doing it right! Practice makes perfect with this exercise and it takes a while to train that neural pathway all the way from your brain down to your big toe! Keep after it though, we are rooting for you!
Heel Raise with Big Toe Extension
This is a great way to work on strengthening the plantarflexor muscles, or the muscle that assist with getting up onto our toes and the ‘push-off’ phase of gait. Using the towel roll assists with getting that extra bit of big toe mobility.
Split Stance Lunge-Big Toe Extension
Let’s make it functional! One of the best aspects of big toe exercises is to work on improving big toe mobility is incorporating big toe extension while performing the walking motion. With this split stance lunge, we are able to work on functionally improving that mobility of the great toe while in a position that is similar to walking.
Big toe pain is frustrating, but we are here to help you get back on your feet with these awesome big toe exercises! With a focus on appropriate joint mobility, strengthening through a range that is functional, and improving your joint mechanics with walking and return to sport related tasks, these exercises can serve as a way to help you get back to the activity you want to do! Hopefully, Fido will stop whining at the door for you to take him out for a walk.
About the Author
[P]Rehab Writer & Content Creator
Dr. Lauren Lynass is a Colorado girl at heart. While she grew up skiing, snowshoeing, and building snowman, she has traded in her snowy mountains for California beach life and currently lives with her husband and dog in their travel trailer “The Burrito.” As a physical therapist, Lauren has experience working with pediatrics, runners, geriatrics, athletes, and itty bitty newborns. She is a Certified Strength and Conditioning Specialist, Level 1 Certified Running Gait Analyst, Dry Needling Certified, and uses her expertise to host sport specific strength and conditioning classes for local high school athletes. When Lauren isn’t treating patients, you can find her running along the Cali coast, hiking with the pup and husband, or simply swinging in a hammock lost in a good book. She considers herself a life long learner and loves that being a physical therapist provides her with the opportunity to do so! She enjoys being a part of the [P]rehab Team as it allows her to collaborate with some of the very best in the field and empower others to take charge and ownership of their wellbeing.
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- Kennedy, J. G., & Collumbier, J. A. (2008). Bunions in Dancers. Clinics in Sports Medicine, 27(2), 321–328. https://doi.org/10.1016/j.csm.2007.12.004
- Michael J. Coughlin, P. S. S. (n.d.). Hallux Rigidus: Demographics, Etiology, and Radiographic Assessment – Michael J. Coughlin, Paul S. Shurnas, 2003. SAGE Journals. https://journals.sagepub.com/doi/abs/10.1177/107110070302401002.
- O’Neill, T. W., & Felson, D. T. (2018, August 28). Mechanisms of Osteoarthritis (OA) Pain. Current Osteoporosis Reports. https://link.springer.com/article/10.1007/s11914-018-0477-1.
- Kumar, S., Kadavigere, R., Puppala, R., Ayachit, A., & Singh, R. (2015, May). Subhallucal Interphalangeal Sesamoiditis: A Rare Cause of Chronic Great Toe Pain. Journal of clinical and diagnostic research : JCDR. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4484121/.