Claire Slater-Gallon from Get Strong physiotherapy explains why we shouldn’t underestimate the role of our big toes in running.
Have you ever considered what your big toe does? Probably not, but there is good reason to include it in your workout routines. My experience of treating runners is that they are enthusiastic about running but less so about strengthening and conditioning. Understanding why you are doing an exercise increases the likelihood of doing it regularly and effectively. This blog aims to give you some insight into the importance of the big toe in running efficiency and offer suggestions on how to include it in your exercises.
The big toe may seem insignificant and runners can run marathons without a second thought to it. Strengthening calf muscles is a key part of training because they are the powerhouse of running. The calves contribute to the bulk of the work involved in the foot striking the floor; absorbing the forces that travel up from the ground through the foot and propelling you forwards. The big toe helps set up the other joints in the foot and the plantar fascia so the calf muscles can generate power. To perform its role well the big toe needs a good range of movement and strength, so let’s have a look at the structure and function of the big toe.
Structure and function
The big toe is four times bigger than the other toes with more muscles attached to it because it bears more weight and produces more power. Unlike the other toes it only has two joints rather than three, allowing for extra stability and power. The big toe has connections to the all other 33 joints in the foot; to the plantar fascia (maintains the arch of the foot), and to the kinetic chain leading to the knee, hip and lower back.
The primary movements of the big toe are extension and flexion (bending up and down). Between 50 and 90 degrees of extension is considered the normal range of movement, most of which is required for running which uses between 50 and 70 degrees. This movement of the toe bending upwards creates a huge amount of essential tension in the plantar fascia, needed for push off during running, which in turn may prevent early fatigue and pain in the calf muscles.
What happens at the big toe affects the rest of the foot; a lack of movement and weakness can lead to a breakdown in the kinetic chain resulting in injuries such as plantar fasciitis, calf strains, knee, hip and back pain. These conditions are commonly attributed to tightness in the calves and hamstrings when in fact, the big toe can be the cause.
It’s simple to check the movement in your big toes and I recommend runners do. You can check their range of movement by lifting them up and scrunching them down, whilst sitting or standing. You could even turn this into a regular exercise to help improve mobility. If you go to a physiotherapist or osteopath with plantar fasciitis or any other foot or calf injury, they should check the movement and strength in your big toes.
Awareness and exercises
Start to become aware of your big toe movements by simply scrunching them, lifting them upwards and spreading out all your toes. Combine big toe movement with strengthening exercises you may already do for your calves. Let’s use the heel raise exercise as an example: stand with your feet shoulder width apart and lift up and down on your tiptoes. Repeat between 15 and 30 times (remember that runners need strong calf muscles, so 30 repetitions should be manageable). As you lift your heels, tune into your big toes, feel the pressure travelling through them and be aware of the ground. They should be participating in the movement (there is a natural tendency to roll on the outer side of the foot as you go up, thus avoiding the big toe, so try to avoid this). You will be surprised at how many people avoid using the big toe during this exercise especially if there is a history of injury. Watch this video of a patient with a history of left plantar fasciitis. You will see that they are reluctant to use their left big toe. https://youtu.be/LvwXsLw6VF0
Due to the big toe being a highly specialised joint, the brain can become protective or reactive if stress or repetitive movements are detected. The brain will send pain signals and reduce movements, however, maintaining the protective or reactive states can lead to stiffening and weakening, the opposite of what we need. By being more aware of our big toes we can check their function and challenge them to move more and to keep them strong.
It’s easy to improve the range of movement and increase your big toe’s strength and flexibility. Here are a few key exercises and you can also check our demonstration videos: www.getstrongphysio.com/exercises/
I hope this blog has helped create a little awareness that will help you towards injury-free running. If you currently have any pain or are unsure about how to do any of the exercises, please seek advice from your physiotherapist or osteopath, or please feel free to contact me for further advice or treatment. You can book or contact us; Callum and myself, Claire, at Get Strong physiotherapy & osteopathy here: www.getstrongphysio.com
Toe extension (good for plantar fascia)
Stand with feet together, looking straight ahead. Lift all your toes up as far as you can and back down. Repeat 20-30 times.
Toe flexion (good for toe joint)
Standing, bend your toes on one foot at a time underneath, apply a little pressure to create more movement. This should not be painful, if it is, reduce the pressure you apply and seek advice. Repeat five times.
Plantar fascia strengthening (good to improve toe range of movement)
Crouch down on to the balls of feet and put hands on the floor in front of you. Lean forwards so that your knees go towards the floor but do not touch it and then back again. Repeat 20 times.
Stand with feet shoulder width apart, raise up on your tiptoes and down again. Be sure to move through your big toes and not on the outsides of your feet. Repeat 20-30 times.
Contact: Claire Slater-Gallon Get Strong physiotherapy & osteopathy www.getstrongphysio.com