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This article is a transcribed edited summary of a video Bob and Brad recorded in July of 2017. For the original video go to https://www.youtube.com/watch?v=xORPFVXv6_M&t=187s
Bob: Okay, Brad, we are going to talk about big toe pain and stiffness. It’s also known as hallux rigidus. We are going to show you 10 steps to cure this.
Brad: Exactly. Bob, we should be correct in our terminology. The big toe is really not the big toe. It’s called the great toe.
Bob: The great toe! Like the great Brad Heineck.
Brad: Oh, wow. It’s good to be compared to the toe.
Bob: The captain. He’s the captain of the foot.
Brad: Anatomically, it is the great toe. Most people call it the big toe though, so we will say that. So, the first MPT joint; metatarsal phalanges. This is the phalanges; your toes are the phalange and the metatarsal is this long bone right here and this black line represents the joint with the motion. That’s the joint that gets the pain, the stiffness, the arthritis and worst-case scenario, which happened to a friend of mine, they actually fused the joint together. So she has no more range of motion.
Bob: Surgically they fused it?
Brad: Yes.
Bob: Because she was having so much pain?
Brad: Yep.
Bob: Not a minor thing because you can’t take a step without that flexing.
Brad: It really changes how you walk, your balance; everything. It’s the last thing you want to do, so, we’re going to show you some of the things you’re going to do to prevent the surgery. The earlier you get at this, the better off you are. So as soon as your toe is getting stiff, we are going to talk about some things to do. One is, what is causing the pain in the joint? There could be a number of things, but one of the big things is footwear. If you have a shoe, and they come in at a tight angle, or a narrow toe, and your big toe is being pushed inward. Also with high heels, that’s even a double whammy because you have the pointed shoes and the weight of your body pushing down. This is just one of the problems. There are other problems that can go along with this, but we are going to stick to the subject.
Bob: It’s a real problem with fashion. My wife worked as a manager at a hotel, and she wore high heels every night with the narrow toe base and now she’s got bunions. That’s all in the same family, wouldn't you say, Brad.
Brad: The other thing that happens is it takes the joint out of alignment but also there’s tendons that make your toe push down which is important for walking and balance. The tendons have two little bones, on the bottom of the foot, and there’s grooves that those bones need to go into to work properly and when the toe gets pushed over, they go out of alignment so that kind of compounds the problem.
Bob: So, everything is out of alignment. The ligament, the tendon and bones.
Brad: The joint itself. So, get a shoe with a wide toe box. And don’t get high heels; you have to stay away from that if you happened to wear those in the past. Also, if you’re walking and you’re to the point where every time you walk, that joint bends and it’s painful and it’s really interrupting your life, you’re going to want to get a shoe that’s really stiff. If you pick a shoe up and you put your one finger at the end and you can bend it easily, that’s not very stiff. If you get a shoe that is stiff, or a motion control shoe. If you talk to a salesperson that knows their shoes, they’ll know exactly what you’re talking about. They are typically walking shoes. Otherwise, you want to put an insert inside to stiffen up the shoe, you can get a carbon fiber insert. That you’re going to have to look around for. I don’t know if you are going to find that at any old store. But it’s an insert that slips in and it makes the shoe base more rigid.
Bob: So, wide toe box, rigid insert, no heels.
Brad: Right, exactly. The next thing is getting that joint moving again. What happens is, the joint will become sore and irritated and since it’s sore when you’re moving it, you move it less. Anytime you move a joint less, it becomes more arthritic, more painful and tighter. It’s a compounding thing and eventually you get to the point where you can hardly touch it and just laying in bed and having the covers touching it will make it painful and then it’s hard to sleep. We want to get that joint moving. First thing, if the toe is going laterally or toward the other toes, we want to pull that toe back in line and do some stretches on it. There are some muscles and connected connective tissue between the toes you want to get and stretch it out. Do it within reason. If it’s really sharp pain, you’re going to have to be gentle. This isn’t going to just take one treatment. It may take a number of days or weeks to get this feeling better.
Bob: Is this a bad time to bring this up, where you may put gauze in place?
Brad: It’s a perfect time! You can just take some gauze and roll it up and you can put that in between your toes. You can buy this gauze at any pharmacy.
Bob: Dr. Scholl’s has these little rubbery type things that you can stick in between your toes.
Brad: That’ll hold the toe in place.
Bob: You want to get that toe realigned again.
Brad: Exactly. You'd have your wide toe shoe and this can be used in addition. It should feel better as a result of it.
Bob: That’s going to work on it all day long, as opposed to the short time your during the stretch now.
Brad: Exactly. Now the next one is how to mobilize this. Now this is where therapists are trained to do joint mobilization. However, I think this is simple enough that you can do this at home.
Bob: You certainly can try some of these.
Brad: You have the tarsal bone, it’s a solid bone. You can grab it and feel it. Get a hold of that bone. Thumb on top, fingers on bottom. It’s right by the big toe.
Bob: Lined up with the big toe. Along the same line.
Brad: So that stabilizes it. Imagine that’s like a vice and I'm just going to hold it steady. Now we are going to work this joint where the black line is. Now, you don’t have to do these in this order, but the first thing I do is relax this foot and pull the toe. Pull your toe up and give it some traction. Hold that for 10-20 seconds. You can do it longer if you can tolerate it and don’t get cramps in your fingers.
Brad: The next one I’m going to do, and you can combine it with some of these, I’m going to do some rotations. Rotate to the right and rotate to the left. I’m going to turn my foot this way. This is like if you imagine a nut on a screw that is all rusted and you have to work it back and forth to loosen it. That’s kind of what you are doing with your toe joint.
Bob: Now, if it really hurts in one direction, I would probably work it the other way more.
Brad: Good point, Bob, exactly. That’s why it’s nice to have two people doing this. One person forgets to say something but the other usually remembers. If I go in one direction and it’s really painful but going the opposite way I get more range of motion, I’ll go that way more. Then I’ll go back to the other direction and see if it loosened up.
Bob: It often does too.
Brad: The next thing I’m going to do is called inferior superior motion. The foot stays stationary and the toe goes up and down. It’s going to be very limited, not a lot of motion there. But you get that joint moving. Again, if it really hurts one way, work the other way more. Then you go back and assess the sore direction again and eventually it’ll get looser.
Bob: It’s amazing how much this helps. It shocks me sometimes. You just start moving that joint around a little bit and it helps.
Brad: Then we go to the major motions. The dorsiflexion or extension and the plantar flexion. I’ll go up and stabilize here and then stretch it. You should be able to get about 90 degrees on a normal toe. If you’re only going up 10-20 degrees you’ve got some work to do.
Bob: By the way, this is something we also do with plantar fasciitis. If you have plantar fasciitis you often find that your toe is tight and will not go up into that extension. It’s a good one to go ahead and stretch it, pressure on, pressure off.
Brad: After that, you may get flared up a little bit. You may need to take some ibuprofen.
Bob: You can ice it too.
Brad: Yes. That may take a week or two and by the time you get the toe moving again where you can actively move it, it’s getting closer to that 90 degree or at least halfway there. Then we want to start strengthening it again. Then we go to our favorite, stretch band, TheraBand; whatever you want to call it. Get just around that big toe, this is kind of cute.
Bob: The great toe.
Brad: The great toe! You should get the yellow band. This red one is a little aggressive.
Bob: If this hurts, you can’t do it.
Brad: Right right. There’s another technique where you put a towel on the floor and try to take all your toes and scrunch the towel. Put wrinkles in the towel with your toes. Another one you can do, get something under your toe (like shaking dice) and you try and squeeze it. Pick it up with your toes. You can go over there and put it down. If you have four or five dice, you pick them up and move them. Just for something to do and it’s working those muscles.
Brad: Remember, that downward motion on that toe is really important for balance. The upward motion is important when you walk. The toe needs that normal range of motion, so you have a normal walking pattern, or gait. If you have the great toe pain, hallux rigidus, that’s the whole treatment method to get through. Good luck with it! We want you out there walking smoothly.
Bob: Thanks.
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