If you have ever injured your big toe you will realise just how important it is. Because toes are hidden in running shoes we often forget what a big role they actually play.
When you run, your first toe carries twice the load of the other four toes. The maximum force through the joint is between 40 – 60% of the body weight.
During the propulsion part of your run the big toe flexes upward under huge levels of stress. The propulsion phase is that moment when the leg passes behind you and your push forward happens.
Gait considerations.
A stiff big toe combined with a lack of calf flexion, can reduce the runner’s use of the gluteus maximus, and thus bring about a gait cycle that uses the hip flexors more than the more powerful posterior muscles such as the gluteus maximus and hamstrings. I often see this when analysing runner’s gaits. The runner will often heel strike and can suffer from injuries such as Illiotibial band syndrome and Patella Femoral Pain Syndrome.
What can go wrong with the Big Toe.
1. The Sesamoids can get inflamed.
These two bones are in the flexor tendon of the big toe, and act as a fulcrum for flexing the big toe.
Inflammation of one or both sesamoids is known as sesamoiditis. This can come about from increasing distance run, doing speed work or hill repeats. Worn shoes can also cause this. The area can be very painful and pain can occur when you flex your big toe upward. Swelling can also occur in the area.
How to treat:
– Ice the area.
– Take some anti-inflammatories.
– You can also place a pad over the area that reduces pressure.
If unable to run properly during the injury, swop across to some other form of training. Running with a limp will bring about other injuries. The injury normally lasts between 2- 4 weeks.
2. Bunions.
A bunion causes a misalignment of the big toe joint. The technical description is a hallux abducto valgus deformity. In short, the big toe points inwards toward the other toes. There is no common consensus as to why this occurs. Many blame tight fitting shoes or high heels as the cause, while others blame things such as flat feet, excessive ligament flexibility and abnormal bone structure. 
In addition to the deformity, the tissue around the lump may swell as well. The big toe may also place pressure on the adjacent toes.
When it comes to running, make sure you wear a shoe with a large enough toe box. Also have your rate of pronation assessed. Excessive pronation together with a lower foot arch can cause the foot to rotate inwardly in the shoe and place pressure on the toe.
Surgery might become necessary if the area becomes too painful.
3. Hallux Limitus
Hallux limitus describes the limited movement of the toe that can occur due to arthritis, gout or injury. Pain is experienced when the toe is flexed upwards.
Treatment includes ice and anti-inflammatories. Manually flexing the toe so as to increase its range of motion will also help. However more intense medical intervention might be necessary.
4. Gout
Gout is a metabolic condition in which uric acid crystals accumulate 
in a joint due to overproduction of uric acid. Attacks of gout are often associated with the consumption of rich fatty foods and alcohol. The joint becomes red and swollen, Anti-inflammatory medications are used to treat an acute episode of gout. Medical intervention might be necessary in order to prevent repeated episodes.
If as an athlete you have never had an issue with your big toe, just take a moment to thank it for its years of trouble free service.
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Regards
Mike.
SBR Sport Swim-Bike-Run 