What does your big toe have to do with your back pain? - A lot!

‍What does your big toe have to do with your back pain? - A lot!

By:  Anna Staehli Wiser, DPT, FAAOMPT

As a physical therapist, I spend a lot of time watching people walk.  When people come to the clinic complaining of back pain when walking, I always take a look at the feet.  Joint restrictions in the foot and ankle are extremely common and have a strong influence on what is happening up above. This article attempts to explain why. 

The big toe acts as a springboard for you to push off of during terminal stance (the last part of the gait cycle right before your rear foot leaves the ground) and propel yourself forward with each step.  If the big toe is not functioning properly, this will alter your gait mechanics and change the way the more proximal muscles are recruited with each step.

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The most important part of the big toe as it relates to walking is the metatarsal phalangeal joint (MTP joint).  In terminal stance, the MTP joint should be in extension, with tension built up through it’s connection with the plantar fascia and flexor muscles in the bottom of the foot.  

‍To further-power the springboard effect described above, the gluteal muscles kick in on the proximal end to extend the hip.  When the springboard mechanism is impaired, the gluteal muscles will not be cued to fire as they should with each step.  When the gluteal muscles are not firing and there is a shortened gait stride, secondary problems can develop, such as tight hip flexors and over-recruitment of less efficient hip extensor muscles like the hamstrings and adductors.  Common reasons why we may not push off adequately through the great toe could be due to stiffness at the MTP joint or ankle that inhibits our ability to transfer body weight through the lower limb properly.

When the gluteal muscles (primary hip extensors) are not engaged adequately, the hip flexors will become short and tight over time as they are not being stretched and balanced out by the hip extensors.  The iliopsoas (primary hip flexor) and gluteals are  antagonists to each other, which means that there needs to be an equal and opposing amount of tension in each muscle to maintain symmetry and balance of forces through the pelvis.  A loss of tension in the gluteals will result in shortening of the iliopsoas, which will create a scenario of postural imbalance through the pelvis, with the pelvis in an anteriorly tilted position.    

‍The pelvis is the foundation for your lower back and spine. When the pelvis is out of balance, it throws off the lower back and will result in exaggerated tension in this area, with the lumbar paraspinal muscles working extra hard to attain an erect position and hold your torso upright.  The hamstrings will be working overtime as well to try and correct the positional fault of the pelvis, which will lead to stiffness and poor flexibility through the hamstrings in due time.  

The chain of events described above is an extremely common underlying reason why many people experience lower back pain with walking.  

Looking at the body and examining the entire kinetic chain starting at the big toe is necessary for uncovering the true reasons for pain.  

If your lower back is hurting when walking, take note of the condition of your feet.  Exercises like heel raises, lunges, and squats can help to balance out your posture.  Also, intentionally pushing off through the great toe when walking is a simple way to retrain your body back into proper gait mechanics.

‍References:

1. https://ericcressey.com/big-toe-big-problems/

2. https://www.integratefitness.com/post/can-your-big-toe-knock-your-glutes-offline#:~:text=Your%20big%20toe%20helps%20to,click%20here%20to%20read%20it.