QUESTION:
Recently, my big toe on the right foot became painful on the inside of the joint and the big toe has begun to drift toward the second toe. My second toe on the same foot looks a bit like it is drawing back toward my foot with the middle second toe joint sitting up in the air a bit. I have had no injury that would have caused this, it is starting to affect the way I walk and is more painful after I exercise. Do I need surgery? How can I get back to walking and exercising without pain?
ANSWER:
There are actually 2 conditions mentioned in the question above: the first involving the big toe drifting toward the second is called hallux valgus which often forms a bunion (thickening of the joint and sometimes extra bone growth) on the inside of the big toe joint. The second condition involving the second toe drawing back toward the foot is called a hammertoe.
There are many reasons why what you are currently experiencing occurs. One of the most common reasons applies to women more than men, because the culprit is due to footwear. Women who wear shoes with heels on them and especially shoes that are narrow, tapered in the front, or shoes that are too tight for their foot size, are at risk for this condition.
Another common reason for the condition mentioned above that affects both men and women is foot type. This is especially common with men and women who have “ flat feet” with a low arch and a heel that rolls in when you look at it from the back. Normally, as you walk, your foot is supposed to hit the ground slightly to the outside of the heel, the foot should roll in a bit. It can drive the body forward off the big toe and then the weight transfers back outward across the toes. A person with flat feet often lands just to the outside of the center of the heel, but when they’re flat, the foot rolls in further than it should. When this occurs, instead of the body driving its weight off the big toe, the foot rotates on the big toe to push off. This phenomenon causes pressure on the inside of the big toe and drives it outward toward the second toe. Over time, this creates the bunion and pain on the inside of the big toe, making the big toe drift over toward the second toe. In addition, as the big toe is driven toward the second toe, the second toe tries to get out of the way to make room for the big toe that is drifting toward it. Thus, the second toe pulls back toward the foot to “get out of the way”.
So … What DO you do about this issue? First off, surgery is a very last resort for this issue due to the fact that toes don’t always respond well to surgery. Oftentimes surgery for these conditions, even with the best intentions, leads to new or worse pain than prior to surgery. In addition, even when the big toe is surgically straightened, it will drift back toward the second toe over time, and the scar that is made behind the second toe to straighten it, ends up pulling the second toe off the ground. However, there are times when surgery is warranted and helpful.
A better option is to see one of the expert Physical Therapists at Cardin and Miller Physical Therapy, as we are non-surgical foot and ankle specialists. Your Cardin and Miller therapist will evaluate your foot and ensure that you are in the proper size and width shoe. In addition, your therapist will instruct you in exercises that will reverse the positioning of the first and second toes. The therapist can also fit you with devices that can assist in the proper positioning of the toes. Also, your Physical Therapist will likely fabricate and fit you with a pair of custom foot orthotics. This will support your arch and help your foot to drive off the big toe properly, which will stop the forces that are driving your big toe over toward the second and causing that toe to draw back.
Call Cardin and Miller Physical Therapy TODAY at 717-245-0400 to schedule your FREE SCREEN so that we can show you how to resolve this issue and get your life back!
If you have a question you would like me to answer in one of my upcoming columns, please email your question to: smiller@cardinmillerpt.com
