The Big Toe and its Brethren

Let’s face it, the big toe can be irritating. It’s often the ugliest toe but nevertheless pushes forward with almost narcissistic aplomb, always ensuring it is one step ahead. However, without it we would fall over. The big toe is intrinsic to our balance and ability to stand and walk. No matter how pushy it may seem, we must take care of it – and remain cognisant of the various complaints that may befall it.

The big toe may try to give the impression it works on its own, but in reality it is merely part of the teamwork in the foot that keeps us upright and on the move. The bones, muscles, tendons and ligaments in your feet provide the base for your entire body weight whenever you stand. There is a complicated map of bones in your feet composed of about a fourth of the bones in your body, along with numerous ligaments, tendons, muscles, nerves and blood vessels.

These bones – just as any of the bones in your body – can be affected by genetics, nutrition and the environment. And also osteoporosis – or more specifically osteoarthritis which affects bones and cartilage, and causes inflammation and pain. But because of the delicate structure of feet, and the pressure they are under, there are number of bone issues that may cause difficulties for people. The big toe is not necessarily chief among these but can contribute to mobility problems along with its brethren, the toes.

Tip-toe

If you’ve ever stubbed a toe, you will know how painful this can be. The foot is tough but also very sensitive. It is also subject to a great deal of wear and tear; the foot and its complicated flexible structure is put to the test all day long. But the big toe, on its own or in the company of smaller toes, carries a great deal of the pressure and responsibility for keeping you going.

Hallux limitus/rigidus: This specifically affects the big toe, causing a decreased range of motion or stiffness in the joint. This may arise from an inherited abnormal foot structure, fracture or repeated trauma, or inflammatory diseases like gout and arthritis.

Bunions: Just below the big toes are bunions. Bunions often have a genetic or environmental component, and are often associated with arthritic changes in the bones and joints. Bunions can progressively get worse over time, becoming red and swollen, and interfering with an individual’s ability to wear shoes and walk without discomfort.

Gout: This is a type of arthritis associated with the body’s overproduction of uric acid crystals in the blood, which then spill into the joints causing sharp pain, redness, swelling and heat.

Hammertoes: These are toes that are bent and contracted. The toes can be flexible or rigid, and are associated with arthritic changes in the toe joints. Painful corns can also be the result of these malformed toes.

Sesamoiditis: Refers to the pain and inflammation of one or two small bones located just beneath the head of the bone behind the big toe. The sesamoid bones can enlarge (hypertrophic), fracture or become inflamed.

Osteoporosis: Osteoporosis can also affect the toes, and can arise from various factors: a family history; lack of calcium in the diet; reduced estrogen after menopause; a drop in testosterone in men; Vitamin D deficiency; sedentary lifestyle; chronic diseases such as Diabetes, Rheumatoid Arthritis, or eating disorders; smoking and alcohol. Osteoporosis can affect anybody at any age, not only the elderly as many people assume. There are two minerals necessary for bone strength, calcium and phosphate. The imbalance between these two can cause a loss of bone density.

Fractures: You might think the big toe and its fellow extremities would remain smugly intact – but this is not the case, and a broken big toe is traumatic. Put succinctly, if you have weakening bones they may fracture – and that includes your big toe. Fractures of the feet often occur with repetitive small trauma like wearing poorly fitting shoes. With the loss of structure comes collapse of joints in the feet causing arthritis and pain. Of the 28 bones in the foot, 19 are toe bones (phalanges) and metatarsal bones (the long bones in the midfoot).

Treatments

  • Rest: Sometimes rest is all that is needed to treat a traumatic fracture of the toe.
  • Splinting:The toe may be fitted with a splint to keep it in a fixed position.
  • A rigid or stiff-soled shoe: Wearing a stiff-soled shoe protects the toe and helps to keep it properly positioned. Use of a post-operative shoe or boot-walker is also helpful.
  • Buddy Taping: Taping the fractured toe to a neighbouring toe can sometimes be helpful.
  • Surgery: If the break is badly displaced or if the joint is affected, surgery may be necessary, and may involve pins.

Wherever you’re going, your big toe is going to get there first. Applaud it! Without it you might not be going anywhere. Love your bones!

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

Find out more about our work at: www.osteoporosis.org.za