Functional stiff big toes are observed every day in podiatry practice. Termed functional hallux limitus. They should not be ignored, as having a stiff big toe can potentially lead to unwanted aches and pains. It is important to understand the huge role the hallux plays in foot biomechanics and gait cycle. Having a stiff big toe can lead to a stiff neck.
The Role of The Big Toe
The big toe is called the hallux. It has a crucial role in normal foot biomechanics. It should be considered as a functional unit to incorporate the metatarsal phalangeal joint (ball) and 1st metatarsal. Podiatrists term it the 1st ray. The anatomical osseous structure of the 1st ray is considerably bigger than those of other toes. It also has 2 small additional bones structures under the joint called sesamoids. These help to guide and protect a main tendon through like a rope in a pulley.
The 1st ray of the foot is considerably larger than it’s neighbours.
The big toe should takes approximately 50% of the weight through the forefoot when pushing, stepping off. It acts like a spring, or think of it as a lever to propel foot forward in what is termed the windlass mechanism. From the heel bone (calcaneum) to the proximal ends of the metatarsals is a structure called plantar fascia. It forms a tight triangular structure like a sling, which when the toes are lifted, it winds up in a tightening fashion to raise the main arch. When the arch is shortened the foot becomes stable, with bones of the foot tightly compacted to help lever foot off the ground. If this action doesn’t happen the foot is ‘unlocked’ and unstable and ‘dropped’ arches can occur.
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What Happens When You Get Functional Stiff Big Toes?
The big toe has to be cranked up properly to help shift the body’s weight forward. It is one of the 1st joints a podiatrist will examine in a biomechanical examination. If a big toe is not functioning properly, for whatever reason it can be considered to be ‘incompetent’. Incompetent means inept, useless and bungling! The main impact of this is the consequence of it’s neighbours taking on it’s work. An additional 50% load and strain is placed on the smaller metatarsal-phalangeal joints, resulting in all sorts of forefoot pathologies:
- Metatarsalgic pain (metatarsalgia)
- Metatarsal joint wear and tear; osteoarthritis
- Fat pad atrophy
- Nerve compression; Morton’s neuroma
- Bunion deformity (Hallux Valgus)
- Toe deformities
- Secondary corns and callouses
- Plantar fasciitis
- Heel pain
- Achilles tendinopathies
- Ankle, knee, hip and lower back pain
- Neck and shoulder pain
A incompetent big toe can cause a stiff neck. This is due to the foot not being able to propel the body efficiently forward. To get forward momentum the shoulders, upper body stoops forward in an attempt to propel body forward. Abnormal wear and tear is placed on the neck.
Functional Stiff Big Toes and Ingrowing Nails
Functional stiff big toes are prone to trauma to the nail plate causing nail pathologies:
- Ingrown nails
- Fungal nails
- Corns under the nail (subungual corn)
- Thickening of nail plate
A chronic ingrown toenail. The patient had lowering of his arches and ‘locked’ big toes. After surgery he was prescribed orthotic insoles.
If a patient keeps getting problems with the big toenail plate, it makes sense to check out the foot’s 1st ray of motion. Invariably there is a biomechanical issue. Often just by lifting up the main arch (medial longitudinal) of the foot more 1st ray function can be achieved. This can prevent further problems with trauma to the nail plate.
How do You Get Functional Stiff Big Toes?
So how does one get an incompetent big toe? There is a multi-factorial answer to this, and it depends on whether it is an anatomical stiff big toe (hallux rigidus) or functionally poor (functional hallux limitus). Both effect the important windlass mechanism and the big toe’s ability to be a sturdy lever and spring.
A stiff big toe is due to arthritic wear and tear caused by direct trauma, repeated repetitive trauma from sport or poorly fitting shoes. Gout can cause arthritic change, being extremely destructive in nature.
A functionally poor big toe can have a hereditary predisposition raising the risk factor of developing bunions (hallux valgus), with a resulting pronounced medial joint deviation. These joints can be too flexible causing splaying of the forefoot and collapsing inward of the main arch. This is still an incompetency.
Hallux valgus (bunion) deformity.
Another consequence of a functionally poor big toe is ‘locking’, jamming of the big toe’s metatarsal-phalangeal joint. It then loses it’s ability as a propulsive lever. The main cause of this is lowering of the foot’s main medial arch This is termed pronation, in-rolling. Pronation means internal rotation of the foot. Pronation is a required part of the gait cycle. It causes the arch to flatten and adjust to the ground’s terrain with internal rotation right up the leg. If there is too much of a pronatory force present, the arch stays lowered more than it should do. The consequence of abnormal pronation is the function of the big toe is compromised. It becomes incompetent to do it’s job efficiently. There is also additional wear and tear on joints, ligaments and muscles throughout the lower limb.
Low arched pronated feet.
Role of a Podiatrist in Treating Functional Stiff Big Toes.
Big toe incompetency causes all sorts of biomechanical issues. The majority of these issues can easily be rectified with good footwear, orthotics and exercises. The problem is many individuals are not aware of this problem in the first place. How do they know they have a functional hallux limitus? They may have a mobile big toe joint off the ground so deem there to be no problem. It is difficult to test a big toe when standing. This is when it is advisable to get feet examined by a podiatrist. If a functional hallux limitus is diagnosed, then a podiatrist is best placed to get it functioning correctly. There are lots of reasons why it may be functionally stiff.
Getting your big toe checked out is a form of preventive medicine. It can save an individual lots of misery in the future. It has a very big role to play in the health and good functioning of your feet and the rest of the lower limb, not to mention the neck. Preventive medicine is key to optimal health and well-being. Feet should be routinely screened for potential future issues as in a routine dental or eye check-up.
