Big Toe Kink in the Kinetic Chain

The stiff and painful osteoarthritic symptoms of hallux rigidus usually occur in older clients, but a sports injury such as turf toe may, in time, lead to reduced range of motion in young adults as well. According to a 2017 literature review, hallux rigidus affects one of every 45 middle-aged people and 35-to-60 percent of the population older than 65.¹ If the brain perceives threat, the joint may become painful in an attempt to offload gravitational stress. This is often the case with a hallux valgus toe, where a bunion forms as the long metatarsal bone shifts toward the inside of the foot and the phalanx bones angle toward the second toe (Image 3.). As for hallux limitus, this condition typically begins with mild restriction of functional range of motion and little MTP joint arthrosis. For some people, however, the condition quickly progresses to hallux rigidus, with full-blown osteoarthritis and bone spurs greatly limiting motion. In this population, the windlass mechanism begins to fail and the big toe becomes locked in a non-functional hallux rigidus position. Referring to big-toe restrictions, my mentor Philip Greenman, DO, stated: “If discovered at an early stage with minimal spurring and the ability to engage the windlass mechanism, I believe manual therapy and a specialized corrective exercise program can maintain that mobility and prevent progression of the deformity. By systematically increasing dorsiflexion at the first metatarsal joint, inflammation and protective muscle guarding may be reduced, leading to symptomatic improvement.”²