The Importance Of Toe Strength

You don’t need strong toes to play the piano or open a jar of pickles, but our toes still play a critical role with every step you take. When you stand up or lean forward, it’s your toes that press into the ground and stop you from falling over. Without strong toes, it becomes much harder to stay balanced and upright. In fact, research out of Victoria University found that toe strength in older adults decreases anywhere from 20-25%, and toe flexor strength is one of the strongest independent predictors of falls. Notably, researchers found that older adults who participated in an exercise program increased their toe strength by an average of 36% in just 12 weeks, in turn reducing their risk of a fall.

But how can you work to improve your toe strength as you age? Walking is a great start, but because today’s shoes are more cushioned and protective than ever, your shoes may be taking a lot of the stress off your toes, limiting their ability to become stronger by handling healthy stress. Besides remaining active, some exercises to consider include:

Lift And Spread – From a standing position, lift all five toes off the ground. Spread them as wide as you can, then reach them forward as you set them back down on the ground. Do this 10 times with each foot. This helps to build dexterity and spatial awareness in our toes.

Toe Alphabet – Sit in a chair, raise one foot up in front of you and pretend to draw each letter of the alphabet with your toes. Flex your toes with the movements instead of just moving your entire leg. Pretend the tip of your big toe is your pencil and draw each letter of the alphabet in the air. Do the same with the other foot to build toe muscle strength and flexibility.

Toe Yoga – Try to lift your big toe off the ground while leaving the other four toes on the ground. Then switch and try to lift the other four toes while keeping your big toe on the ground. Alternate between these lifts on both legs for 30-60 seconds. This will help strengthen your toes and build a stronger relationship between your brain and your toe control.

Marble Toes – Put a small object like a marble or a pair of dice on the ground. Use your toes to pick the object up and move it a short distance before trying to set it in a small cup or a specific spot on the floor. This works the toe muscles to grab and hold the object, but it also develops precision movements by asking you to release the object in a specific area.

Don’t let weak toes contribute to a devastating fall in your golden years. Take a couple of minutes each day to strength your toes and ensure they are strong, stable and capable of keeping you upright. For more information about strengthening your toes or treating to injuries, reach out to Dr. Silverman and his team today.

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Improving Flexibility After Big Toe Surgery

Whether you needed a surgical procedure to address a bunion, a fracture or some other problem that compromised the integrity of your big toe, you’ll want to be proactive during your recovery in order to restore as much normal motion in your big toe as possible. Here are some tips to do just that, but as always, the advice of your treating physician trumps any general information you’ll read below.

1. Rest – One of the best things your can do for your big toe in the immediate aftermath of a surgical procedure is to give it plenty of rest. Tissue damage will be at its most severe in the first few days after your procedure, so give your body some time to recover from the rigors of a surgical operation. Rest alone won’t help you make the strongest recovery, but it helps to protect the area when it is at its most vulnerable after surgery.

2. Adherence To Doctor Recommendations – Similarly, you’ll want to follow your doctor’s specific instructions when it comes to activity restrictions. Do not drive or return to work before you have been given the green light by your physician. Pushing your body too hard too shortly after a procedure can to additional damage to recovering structures. If you want to make a strong recovery, you need to avoid a setback during rehab, and that begins by adhering to the restrictions put in place by your doctor.

3. Physical Therapy – After a few days or weeks, your doctor will likely refer you to a physical therapist for treatment. PT is the recovery technique that will do the most in terms of helping you regain as much flexibility and range of motion in the affected toe. Physical therapy helps by targeting specific soft tissues that have been damaged by the procedure or weakened as a result your recovery process. Simple movement exercises will strengthen and stabilize your big toe joint, which will expand your flexibility and make these movements more comfortable. Do not skip your outpatient or home-based PT exercises.

4. Stretch – Similarly, you can work to continue your recovery by doing some simple toe stretching exercises every day once you’ve been cleared for movement by your surgeon or PT. These stretching techniques are a little more informal than the exercises you’ll perform during your physical therapy sessions, but it will serve a similar purpose in the end. You can find some gentle toe stretching exercises by performing a simple Google search or by asking your PT for some exercises based on your specific needs. Some simple exercises include drawing each letter of the alphabet with your toe, or trying to pick up a marble or small towel off the floor using only your toes.

5. Keep Pushing – Finally, if you really want to restore normal motion in your big toe joint, you can’t settle for good enough. Even if any pain associated with your procedure has subsided, don’t give up on your therapy or stretching exercises until you’ve hit your recovery goals. Many people stop just short of a full recovery when all they needed was to keep pushing themselves a little longer. It only takes a couple of minutes to complete your toe mobility exercises and stretches, so do them every time you sit down to watch television on the couch or before your get out of bed each morning.

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If one or more of your toes doesn’t lay flat when your foot is on the ground, you’re not alone. Millions of Americans have one or more “floating toes,” and while it may not currently be painful, that doesn’t mean you can just ignore it indefinitely. In today’s blog, we take a closer look at the causes of floating toes, and we talk about effective treatment options.

The Causes And Symptoms Of Floating Toes

A floating toe occurs when one or more toes are permanently lifted off the ground when your foot is in a neutral position. Although it can develop in any toe, the condition tends to be more common in your second toe. When your toe doesn’t lie flat, it is not in a natural position. Your toes should be in contact with the ground about 75 percent of the time when we’re walking, so if the toe isn’t where it’s supposed to be, it can’t provide the necessary support to the foot complex. Other areas can pick up this slack, but this shift in stress distribution can have long term consequences for your feet, including the eventual onset of chronic metatarsalgia.

But what causes a floating toe to develop? In many cases, they develop as a result of footwear choices, acute injury or genetics. For example, poor footwear can lead to a tightening or loosening of the extensor tendons or ligaments in your toes, leading to positional changes. Poor footwear can also increase your risk of a bunion, and as your big toe shifts out of natural alignment, it can cause alignment issues for your adjacent toe. Acute injury or a genetic predisposition to metatarsophalangeal joint stiffness or metatarsal shifting can also cause your toes to lift off the ground.

Symptoms of a floating toe include:

• A toe that is lifted off the ground when attempting to lay it flat
• A flexible or stiff bend in the joint in the affected toe
• Visual misalignment of the toe

Floating toes aren’t always painful, but they can be uncomfortable. Just know that the absence of pain does not mean that the condition can just be ignored.

Treating Floating Toes

As we mentioned above, an untreated floating toe can lead to other issues in your feet, so consider talking to your doctor if you notice that one or more of your toes doesn’t lay flat on the ground. In many instances, your floating toe is actually another condition in disguise, and we’ve talked about many of those conditions on the blog. Your floating toe may actually be an early stage:

• Bunion
• Hammertoe
• Claw Toe

In many cases, these issues can be resolved or progression can be halted by pursuing conservative treatment options. Switching to a more supportive shoe and partaking in some physical therapy exercises can oftentimes help your toe regain a more normal position. You’re not going to be able to completely shift your bunion back into a normal position, but you may find that symptoms or progression fade, which is helpful.

In the rare instance where the condition is painful and not responding to conservative care, your doctor may recommend a minimally invasive surgical procedure to address the affected bone or soft tissue. Your surgeon can speak in greater detail about the specifics of the procedure should it get to this point, but oftentimes a painless floating toe does not warrant this type of treatment.

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According to medical experts, the toe belonged to an “early human ancestor dating back 1.6-1.8 million years old.” The research was published in the peer-reviewed journal South African Journal of Science, and it analyzed a discovery made by archaeologists in the Swartkrans Cave in South Africa.

Oldest Known Fossil

The team said that advances in 3D imaging methods made it possible for the cancer diagnosis to be uncovered. Scans of the toe bone fossil were compared to modern-day cases of osteosarcoma, which is a cancer that begins in the cells that form bones, and they instantly noticed similarities between the images. The said that there would not be any reason “to suspect that primary bone tumors would have been any less frequent in ancient specimens.”

Researchers added that the osteosarcoma found in the fossil was likely “not related to lifestyle and often occurs in younger individuals.”

The diagnosis means that this becomes the oldest known cancer case found inside a bone in history. While organs and skin are prone to decay, bone can be preserved for millions of years in fossils.

So while we may not pay much attention to our toes, it’s amazing to think that more than a million years ago, a human ancestor passed away and their toe was preserved for centuries to allow us to eventually make the earliest cancer diagnosis on record!

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Our toes are the last part of our body that handles force as we push off with our foot to walk or run, so if something is wrong with your toe, you’ll notice it with every step you take. But what could be causing this pain when pushing off your toe, and how can you best treat it? We answer those questions and more in today’s blog.

Toe Hurts When Pushing Off

If you’re experiencing pain in your big toe when pushing off the ground when walking or running, you may be dealing with a couple different issues. Here’s a look at three of the most common problems that present with this symptom, and how to treat them.

Turf Toe – You may have heard this term if you are watching a football or soccer broadcast, and while it is true that it tends to affect athletes that make quick and sharp movements, it’s not isolated to athletes. Turf toe occurs when you sprain one or more of the ligaments around your big toe joint. This can be caused by a sudden, forceful movement, or as a result of repetitive stress, which is commonly seen in runners. The best way to treat turf toe is with acute rest followed by targeted physical therapy. Your doctor may recommend a few weeks of RICE (Rest, Ice, Compression and Elevation) along with anti-inflammatory pain medications. After a couple weeks, physical therapy exercises to stabilize and strengthen the joint may begin.

Metatarsalgia – Metatarsalgia is a condition that is categorized by irritation or inflammation of the metatarsals of your feet. Your metatarsals are the long bones that run from your foot arch to your toes. Oftentimes pain is felt just beneath your second, third or fourth toes, and it’s worse when you’re walking or running. You can learn more about the condition on this page, but as for treatment, it’s similar to turf toe. You’ll want to reduce physical activity and stress on the area in the short-term, and then eventually add some strength training exercises that improve the supportive tissues in your arch and forefoot.

Toe Fractures – The final condition that could be causing pain when you push off is the most easily identifiable condition, and that’s the toe fracture. Now, you may not know whether your toe is fractured or bruised, but odds are there was an acute moment of injury that led to your pain onset. For example, maybe you stubbed your toe on a chair or dropped a heavy item on your toes. It’s pretty easy to determine why you’re experiencing pain when you push off your toe if it happens after acute trauma to the area. Unless it’s a crush injury, doctors usually treat bruised and broken toes the same way, with rest, pain medications and gradual return to weight bearing activities.

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The following are some casual musings from a former patient who had one of his toes removed. He gave us permission to share his thoughts with our readers. Hopefully you find them as entertaining as we do!

Casual Observations On Having A Toe Amputated

1. The chances of stubbing my toe has decreased by ten percent.

2. My left shoe is no longer tight.

3. I anticipate ten percent less wear and tear on my toenail clippers.

4. My grocery bill has gone down; now I only have one Piggy that eats roast beef.

5. Having one less toe on the left foot (and therein less friction with the floor) causes me to curve slightly to the right when walking barefoot.

6. If you use your fingers and toes to count like I do, you need to get comfortable with the numbers “nine” and “nineteen.”

7. It doesn’t take quite as much effort to keep me on my toes.

8. My chances of getting frostbite are lower than yours.

9. A shark will never be able to bite off all of my toes!

10. I get a ten percent discount on my pedicures.

11. I’m easier to track when walking on the beach (or in the snow if you’re into walking barefoot in the snow).

12. Unfortunately, you will always come up short when going “toe-to-toe” with someone.

13. If you have “two left feet” make sure the surgeon knows this before you go in to the operating room!

“I got my toes in the water, ass in the sand
  Not a worry in the world, a cold beer in my hand,
  Life is good today, life is good today!” (Zach Brown Band)

 – Nine toes or ten… it’s all the same!

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Dealing With Chronic Toe Pain

If you’re dealing with regular instances of toe pain, we’re going to assume that there’s something structurally wrong with your foot as opposed to a fracture or bruise that is the result of an acute injury. Dull or chronic toe pain that is not caused by an acute injury could be caused by a few different issues. We’re not going to try to diagnose you without seeing your foot in person, but some common issues that could be contributing to your discomfort include:

• Hammer toes
• Bunions
• Arthritis
• Bone spurs

While each of these conditions requires their own unique treatment, they do have one thing in common – They aren’t going to get better on their own. In fact, left untreated, these conditions only tend to get worse. Eventually, if they get bad enough, you may not be able to get back to a pre-injury level of function. Essentially, if you’re dealing with chronic toe pain, you need to do yourself a favor and have the injury examined and treated.

Dr. Silverman will ask about your symptoms, review your medical history and then conduct a physical exam. From there, he’ll likely conduct an x-ray or similar imaging test in order to pinpoint the exact location of trouble. Then, after a precise diagnosis has been made, he’ll walk you through all your treatment options.

For many of the conditions listed above, all you need to do is to make some small daily changes in order to make symptoms alleviate. It could be as simple as changing your shoes or improving your diet, or treatment could be a little more hands-on. Whatever you need, Dr. Silverman will be able to walk you through your course of treatment.

In the event that surgery is required, he won’t pass you off to another surgeon, either. Dr. Silverman has decades of experience and can address many toe issues with a minimally invasive procedure. Making only a couple tiny incisions, he can correct your foot deformity or blast away bone spurs and have you back to pain free walking in no time. Surgery won’t be his first choice, but if it comes to it, you know that you can trust Dr. Silverman when it comes to time operate.

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Common Types of Toe Injuries

Here’s a closer look at a number of different toe injuries commonly suffered by children.

• Cuts, scrapes or lacerations
• Bruises and bone bruises
• Jammed toes
• Toe fractures
• Toenail breaks or damage
• Subungual hematoma (blood clots on the nail)
• Toe dislocations

Diagnosing and Treating Toe Injuries

Some of these injuries can be treated at home by Mom and Dad, while other ones require a doctor’s attention. If you’re questioning whether you should bring them in, it’s probably a good idea to have them looked over by a professional. If pain is intense, doesn’t fade after 24 hours or gets worse, or if the cut may require stitches, have a foot specialist take a closer look.

Your specialist has a number of tools in their arsenal to make a complete and accurate diagnosis. They’ll begin with a physical exam and by asking you or your child about the injury and the symptoms. That may be all they need in order to come up with a diagnosis and a care plan, but for more serious injuries, or ones that can’t be fully diagnosed with a physical exam, imaging tests may be ordered. If a fracture or dislocation is suspected, or if they want to rule out these conditions, an X-ray might be ordered. An MRI or CT scan may also be ordered, but these tests for toe injuries are rare.

Once your doctor has come up with a diagnosis, they’ll walk you through a treatment plan. Some common treatment options include:

• Rest
• Ice
• Bracing
• Casts
• Elevation
• Activity Modification
• Stitching and Bandaging
• Surgery

Your doctor will walk your through the specifics of your treatment based on your specific diagnosis. Many minor or mild toe injuries have great treatment success with conservative care and a little time to recover. For more serious injuries, a more hands-on approach and increased recovery time may be needed, but these also often yield great results.

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Jon Jones defended his light heavyweight title for the fifth time on Saturday despite suffering an open toe joint dislocation to the big toe on his left foot.

Jones defeated Chael Sonnen by TKO with 27 seconds left in the first round to retain his title, but the talk after the fight was how Jones continued to battle after suffering the gruesome injury.  You can see a video of the incident below at the 1:06 mark.

http://www.youtube.com/watch?v=Uk6JxKrxwIQ

As the video shows, Jones suffered the dislocation after his big toe caught on the floor as he was sliding forward.  Luckily for Jones, neither he nor the referee knew how seriously he had injured his foot.

When discussing the injury in a press conference after the fight, UFC President Dana White said if the refs had known how bad the break was “they would have stopped the fight [at the end of round 1]. That’s a fact.”

Trainers addressed the toe while Jones gave his post-fight interview in the ring.  He left the arena without assistance, but he later went to the hospital to undergo surgery.

Jones said on Twitter that his bone broke through the skin.  He tweeted early Sunday morning that his big toe was back in tact and that he had undergone a successful operation.

All done, heading out pic.twitter.com/6DBCIrD5VI

— BONY (@JonnyBones) April 28, 2013

Dr. Silverman comments

It seems that Jones didn’t have a fracture. Instead, he simply sustained an open toe joint dislocation.

The joint that Jones dislocated had to have been the Interphalangeal joint of his left great toe. This is the smaller of the two joints in the big toe. While most people who follow sports are familiar with traumatic injuries to the large toe joint (the classic Turf Toe Football injury), injuries to the interphalangeal are rare. Dislocations are exceedingly rare and the first report of an open dislocation appeared not too long ago.

Sprains to this toe joint are often self treated and only require a doctor visit if long term problems arise.  Long term injuries include cartiledge disruption, pain, swelling and decreased push off power.

Jones is going to need to rest this joint. For the next three weeks it will need to be splinted so that the ligament can heal in the correct position. After that, he can begin gentle range of motion exercises, but he should not stress the joint until good scar tissue has formed around six weeks.

Longer term, he is at risk to develop osteochondral injuries and arthritis. Given his demonstrated pain tolerance, I bet he ignores any pain from this joint for many years.

Related source:  ESPN, Huffington Post

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