Big Toe Woes: One way to learn to load the head of the 1st metatarsal

On Thursday morning, while sprinting up a hill on the latter part of a run, I had the fortuosity of catching my big toe on what I beleive was an exposed root and fell sudddenly. Instinctively I rolled to protect my back (as you often do if you have had any history of back injuries). After a few expletives and a bruised ego, I took inventory of my body: back was fine, an abrasion and contusion on my left elbow and a really sore big toe. I got up and decided to run home as I was less than a mile from there.

I immediately noticed that my gait would need to be altered if I was going to make it home. I had injured the distal interphalangeal joint and distal phalanyx from the best I could tell; loading them in any way brought excruciating pain, so I was forced into one of my mantra’s: “Keep your toes up”*. I did this for the rest of my run and noticed, probably more than ever, how much this simple technique shifts the weight to the head of the 1st metatarsal and sesamoids. It also made me make my gait more “circular” (rather than pendular, another thing we teach in gait retraining).

I made it home and promptly iced. After getting to the office, an X ray confirmed my suspicion of a fracture in the proximal portion of the distal phalanyx. A day later and from my distal to my 1st metatarsal phalangeal joint is sausage like and a beautiful violet color. I am grateful I did not seem to injure the MTP…Oh well, I will either have to run carefully or switch to mountain biking for the next few weeks. Some ipriflavone (to assist in calcium absorption), cucumin and essentail oils (for inflammation) and I was good to go. Yes it throbs a bit, but it is a reminder that I need to push off through the head of the 1st : )

Try “toes up”with your peeps and let us know how it goes.

TGG

* “Toes up” technique involves conciously firing the anterior compartment muscles, particularly the extensor digitorum longus. It fires more into the extensor pool and assists in firing ALL your extensors through spacial and temporal summation and also heps to shut down flexor tone through reciprocal inhibition. It will also help you to rocker through your stance phase and get more into your hip extensors.

What’s up, Doc?

Nothing like a little Monday morning brain stretching and a little Pedograph action.

This person had 2nd metatarsal head pain on the left. Can you figure out why?

Let’s start at the rear foot:

• limited calcaneal eversion (pronation) L > R. The teardrop shape is more rounded on the left. This indicates some rigidity here.
• note the increased pressure at the  medial calcaneal facets on each side with the increased printing
• very little fat pad displacement overall

Now let’s look at the mid foot:

• decreased mid foot pronation on the L. See how thin the line is going from the rear foot to the forefoot along the lateral column? This indicates a high lateral longitudinal arch

Now how about the fore foot?

• increased printing under the met heads bilaterally; L >> R
• increased printing of 1st met head L >> R
• increased printing at medial proximal phalynx of hallux  L >> R
• increased printing of distal phalanges of all toes L >> R

 Figure it out?

What would cause increased supination on the L?

• short leg on L
• more rigid foot on L
• increased pronation on the R

Did you notice the elongated 2nd metatarsals (ie: Morton’s toe) on each foot?

Here is what is going on:

• there is no appreciable leg length deformity, functional or anatomical
• The Left foot is more rigid than the Right, thus less rear, mid and fore foot pronation, thus it is in relative supination compared to the right foot

do this: stand and make your L foot more rigid than the right; take a step forward with your right foot, what do you notice?

• Can you feel how when your foot is supinated
• can you see how difficult it is to have ankle rocker at this point? remember: supination is plantar flexion, inversion and adduction
• Can you feel the weight of the body shift to the outside of the foot and your toes curl to make the foot more stable, so you do not tip to the left?
• now, how are you going to get your center of mass forward from here? You need to press off from your big toe (hallux)

Wow, does that make sense now?

What’s the fix?

• create a more supple foot with manipulation, massage, muscle work
• increase ankle rocker by training the anterior compartment (shuffle walks, lift/spread/reach exercise, heel walking, Texas walk exercise, etc)
• have them walk with their toes slightly elevated
• we are sure you can think of more ways as well!

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