Fixing a Stiff Big Toe
This little piggy went to market…
Probably the most common area for arthitic changes in the foot is the first metatarsophalangeal joint (MTP joint).
During normal gait the entire body must advance over this single joint, so you can see how a restricted MTP joint can be responsible for countless conditions and injuries. Many foot and ankle problems, knee pain, hip and back pain, and even cervical or shoulder problems can be traced back to a stiff big toe.
If you can’t advance over a stiff big toe, you’re going to find a way around it. Depending on how the rest of your body moves, these compensations can lead to wear’n'tear elsewhere.
In addition, given enough time your stiff big toe becomes arthritic and known as a hallux rigidus, another fancy term for a stiff big toe.
In an effort to address a stiff big toe, many health professionals will attempt to fix the issue by going to the supposed source of the problem, the 1st MTP joint. While this may provide some measure of improvement, experience shows that we need to look at foot mechanics a little more closely.
To achieve normal big toe extension (MTP dorsiflexion), the first metatarsal head must be able to plantar flex as part of the Windlass Mechanism that restores the longitudinal arch of the foot during gait. Failure of the active musculature that contributes to the Windlass Mechanism, namely flexor hallicus longus, prolongs pronation (the arch stays flat for a longer period of time than normal) resulting in inhibition of peroneus longus (fibularis longus).
Peroneus longus attaches to the proximal aspect of the first metatarsal and provides a stabilizing force that allows the 1st metatarsal plantar flexion to occur. If this doesn’t happen due to inhibition associated with prolonged pronation, the first metatarsal remains dorsiflexed and blocks 1st MTP joint extension, and you get a stiff big toe.
So if we cut to the chase, the fix is to restore 1st metatarsal plantar flexion and restore flexor hallucis longus function.
Here’s a video sequence showing how I restore 1st MTP joint extension with a 1st metatarsal-cuneiform mobilization and some ART to the flexor hallucis longus.