“By the way, I’m scheduled to have surgery on my big toe in two months.”
A client mentioned to this me as I as about to wrap up a series of sessions devoted to her knee. We call these door knob questions. This is when a client recalls crucial, burning questions in the last minute of their session just as the healthcare provider is reaching for the door knob. My ears always perk up when these questions come up.
Understanding Big Toe Pain
I evaluated her toe confirming her diagnosis, hallux limitus. This is a common first toe joint condition characterized by pain and limited flexibility at the first metacarpophalangeal joint. Big toe pain can arise from various conditions, including:
Turf Toe: A sprain of the big toe joint often resulting from repetitive stress or sudden injury.
Hallux Limitus/Rigidus: Arthritis(rigidus) or stiffness(limitus) in the big toe joint, limiting movement and causing pain.
Bunions: Bony bumps that develop at the base of the big toe, leading to misalignment and discomfort.
Sesamoiditis: Inflammation of the small sesamoid bones beneath the big toe joint.
Physical therapists are experts in clinical diagnosis. PTs are able to differentiate hallus limitus from hallux valgus, bunions, sesamoiditis and turf toe through a series of thoughtful questions and special examination tests. In this case the biggest exam findings were the client’s age (30 years old), location of pain (top of the metatarsophalegeal joint), and her mild to moderately limited first toe extension. If she were older and had moderate or marked limited toe mobility along with signs of toe deformity or osteophyte growth then we would consider hallux rigidus. If the pain was located under the bottom of her toe then sesamoditis would have been considered.
Customized Treatment Plan
First toe stretch for limited toe mobility in a runner with hallus limitus
Based on the assessment, we were able to develop a personalized treatment plan tailored to her specific needs. As her toe was limited in extension, we provided manual therapy, and dry needling to help decrease pain and improve range of motion. We reinforced this through giving her a home exercise plan to help maintain her mobility.
One of her biggest complaints was pain using her current footwear. We recommended sneakers with wider toe boxes as well as shoes with rocker bottoms to help decrease the pressure on the first toe as well as decrease the range of motion needs through using the shoe’s technology.
Manual distraction of the first toe to help decrease pain with hallux limitus and hallux valgus
In addition to limited first toe extension, this client demonstrated limited first toe mobility in all directions as well as poor toe coordination. We recommend toe spacers and toe yoga to help restore the mobility of the first toe and to put it in a more ideal position to help decrease it’s pain.
Lastly, we were able to look up her movement chain to her knee and hip. Excessive pronation at the foot can place more pressure on the first toe. A goal of treatment is to reduce this movement through footwear, orthotics and taping. However, pronation can be driven by the knee and hip as well. Exercises to improve hip coordination and strength support the foot in a more neutral position. These can lead to less pronation and more comfort!
Tootsie rolls or standing hip clamshells are useful to improve hip strength and control to reduce the effects of pronation in runners with foot and ankle pain
Ongoing Support and Training Optimization
Our goal is to help you return to running as quickly and safely as possible. We provide continuous support and guidance to optimize your training regimen, ensuring you can train effectively and compete at your best without the hindrance of big toe pain.
At the end of our plan of care, this client proclaimed “my toes are doing super well! I'm converting everyone to the barefoot shoe and toe yoga life, haha. The surgeons in DC have already lost two clients by now.”
This warmed my heart. Messages like this are what keeps a physical therapist running!
Now, we may not solve every foot issue. However, the old school treatment of just put feet in orthotics is slowly giving way to smarter, conservative interventions like a wider shoe, or strengthening the toes. These treatments can go a long way in reducing pain and improving mobility!
Take the First Step Toward Pain-Free Running
Don’t let big toe pain derail your training or prevent you from achieving your racing goals. Contact Norton Physical Therapy and Performance today to schedule a comprehensive assessment and take the first step toward pain-free running. Together, we’ll develop a strategy to eliminate your pain and enhance your performance.