Mobility for Dysfunctional Hallux joint

Hey everyone,

I've been doing some GST for the last 6 months or so with a friend, and just made the plunge to actually buy the programs myself. Have been working through the foundation, handstand, and mobility series for the last few weeks and am already seeing some progress.

Anyway, my question is does anyone have some recommendations for exercises to help increase the range of motion in the Hallux (big toe) joint? The curled seiza and calf raises seem like they will help over time, but I'm wondering if there are some other exercises (perhaps similar to the first knuckle pushup exercises) for the Hallux joint?

Fixing this dysfunction is particularly important to me as I play Basketball professionally and every degree of extra mobility will translate to an increase in running efficiency.

Any help or advice would be greatly appreciated.

Below is a quick video with to demonstrate my current range of motion.

https://dl.dropboxusercontent.com/u/24451670/VID_20160208_132622.mp4

Thanks in advance!

How is the passive ROM? In other words if you just sit down and hold the big toe how far back can you take it?

The heel raises in the course are also excellent for this. To develop ROM, it may help to use a support, table, back of a chair or wall. Be less concerned about how many reps and more about working to really milk out the ROM. You can do this for time instead, say 1 minute per angle to start.

Another thing is at the top of a heel raise, it's not just a push. If you push with the toes, obviously they will extend and not flex. At the top of the rep, the toes will actually 'pull' you up.

Thanks for getting back to me Cole. Static range of motion is about the same as the max range in the video. I wasn't actually doing a calf raise in the video, I had my weight mostly on my other foot and just tried to take the joint through it's full range of motion.

When you say "heel raises" are you referring to the calf raise exercise in the stretch series?

Yes, heel raise is another name for calf raise, sorry.

Wow, that is some seriously compromised big toe ROM. 

Have you seen a podiatrist about this?

What does it feel like when you stretch it, and where?

And a quick off the cuff idea, Stand on a 1-2 inch dowel and massage the heck out of the sole of your foot.

Yeah tell me about it! I'm not sure how I, or one of the 50 odd physios, atheltic trainers, PTs I've worked with over the years, didn't pick up on it as major point of dysfunction sooner. I've known about it for about 2 years now, however I've been playing pro and high level basketball for over 10 years now. I spent about 6 months working on it with a podiatrist, who developed some non-rigid orthotic innersoles for it. But after about 6 months of constant trial and modifications on them, they ended up doing more harm than good; causing a stress reaction in my third and fourth metatarsal). So I scrapped them and went back to just wearing the innersoles that come in shoes.

When I stretch it out I feel it mostly on the bottom of the ball of the joint. I don't really feel anything on the top of the joint, so I doubt that I've developed any bone spurs there yet. I don't feel much of anything through the arch of my foot or through my plantar fascia, but can feel some tension on the medial side of my Achilles tendon if there is also tension through my calf.

I'll give the dowel a try. I've tried a few different things for massaging through my arch/plantar fascia, spike dog balls, golf balls, etc, but haven't tried a dowel before.

Thanks again for the advice, much appreciated.

(Sorry for the slow replies, since I have a relatively young account I'm still waiting on posts to be approved by a mod.)

Hi Auryn, 

First, I’m sorry that the experts you worked with didn’t pick up on the toe issue or recommend a sustainable plan to correct it. I can't say I'm surprised though. You’re stiff big toe is one thing, but your ankle seems quite stiff too and plantar-flexed. I’ve seen similar cases with basketball, hockey players, and ski aficionados I’ve worked with. As I’m sure you know, a rigid big toe will cause other parts of your body to compensate when you walk/run/play, placing an increased strain up the chain. Over time, the imbalance may cause pain and fatigue in other structures. I could just recommend 2-3 exercises and call it a day. Skip now to bottom of post, if you just want this. But I usually explore the root cause(s) of a problem, to the degree possible, which may help you craft your own solution. The first thing I look at is:
 

1. Environment. 

What kind of shoes do you wear most of the time?

The majority of athletic/running shoes that people wear regularly feature a 12-15mm heel-toe drop or offset and lots of cushion. This design and cushioning promotes an unnatural gait, with the heel striking the ground first in a less mindful manner than you would with thinner soles or barefoot, and followed by a quick slap of the forefoot. Shoes have altered our feet/ankle mechanics for the worse: shortening our Achilles tendons and calves muscles over time. If that weren’t bad enough, the heel elevation places the MTPJ (metatarsophalangeal joints) in a chronic extended position and the first toe pays a big price! Not to mentioned that shoes, in general, make our feet dumb and reduce their proprioception. We've become so addicted to our shoes' numbing effect, it's difficult to imagine functioning without it, much less actually doing so. In contrast, the athletes with the biggest need for proprioception (martial artists, boxes, gymnast, dancers…) wear minimal foot wear or none.

Do you ever walk or train bare foot? If you’re not doing it already, you need to start doing it – very incrementally of course. 

Personally, I cannot find a good reason why our heels should be elevated above our forefoot. Nope.

Thankfully, some manufacturers have woken up to the increase in orthopedic dysfunctions and have introduced moderately minimalist shoes that typically have a 4-10mm heel-toe drop. You can also find some more “radical" minimalist shoes in the 0-4mm range. Why is this important? 

A gradual change towards minimalist shoes will incrementally allow your ankles and MTPJ to regain their optimal length. Please keep in mind that adapting to a minimalist approach should take months, even YEARS, since most of us have been wearing dumb shoes for most of our lives. Otherwise, a calf strain or tendonitis will soon follow.
 

2. Function vs Marketing. 

Sadly, much of the shoe industry (athletic included) has prioritized aesthetics over function–even when they market “function." At some point in time, someone decided that tapering the toe box of dress shoes looked good and the trend carried over into athletic shoes. Fashion has given us a whole world of cool-looking, comfy, cushioned shoes. What all of them have in common is pointy or semi-pointy toe boxes (including sneakers) that squeeze our toes OUT of their natural state. Thanks a lot! 

The simplest thing you can do is to take your shoes off as often as possible. You can also reappraise your shoe collection. Change is good and your feet will thank you. I’ve helped many of my clients in this process. Shopping for the right shoes is almost as important as shopping for whole, nutrient-dense foods (ingredients). 

We need to be responsible about transitioning to minimalist footwear. Don’t get caught in the hype that minimal shoes will solve the problem alone.

If you aren't already, you can start wearing zero drop shoes. The term "zero drop" simply means that your foot is resting naturally inside your shoes, with no artificial elevation, just like if you were walking/running barefoot. Personally, I use zero drop shoes for the reasons I've already stated.

My favorites are Inov-8 Bare for indoor training (if I’m not going barefoot) and Altra shoes. The Altra’s have more cushion and I use them to walk around the city a lot. They are fabulous because in addition to the zero drop, they have a WIDE TOE BOX. These features help engage more muscles in the foot + lower leg, and build a foot structure that is capable to cushion the impact on our bodies. So I wear these to strengthen my feet muscles in their natural position while walking on concrete. 

At my studio, I walk around in Crocs®. Yes, Crocks! Funny looking, but I can spread my toes all day long and I can also wear my Correct Toes® with them. For now, I’m probably the only person in NYC wearing Crocks in a fitness environment. I'm not counting on this trend catching on anytime soon, haha. But I’m happy not fitting in. 

Clearly, some of our modern comforts (shoes) are making us dysfunctional in terms of natural movement. If you see your feet as your foundation and interface with the ground, it’s easy to understand that you cannot possibly perform optimally, if your feet are weak, tight, numb or untrained because they're confined in conventional shoes (read coffins) all day long! Your shoes may not be the only factor contributing to your toe/ankle issues, but given the time you spend in them, they're bound to have a big effect.  

For more info on CorrectToes® or Altra shoes, just Google the names. I’m not affiliated with them, but I highly recommend them. There are several other brands to explore. 

3. Forget orthotics. 

So many of my clients come to me wearing orthotics. "I have a high arch. I need orthotics. I have a low arch. I need orthotics. I have a bunion, I need orthotics…” Really? These days EVERYBODY needs orthotics because their feet are so damn weak!! It makes me furious because I’ve been there. I used to wear orthotics back in the day when I developed plantar fasciitis from kickboxing and teaching too many classes. I’m not saying there’s not a place for wearing orthotics to facilitate certain reactions in the foot. But their use has to be accompanied by proper treatment with the intention of making the individual independent, along with some hard work. It takes work on your part to correct foot/toe dysfunctions and there are no real shortcuts. I’m orthotic free now and so are many of my clients. 

4. Mobilize > Strengthen  > Integrate > Diversify.

Most of us need to continue to mobilizing and strengthening our feet the way they’re supposed to work, in all planes of motion like Nature intended. Try to walk on different surfaces; grass, uneven terrain, snow, stones… Long beach walks are my #1 favorite. 

I would continue doing your FS series consistently. I just bought the SS and I see there are many good ankle/toes mobilizations there. Also what Cole mentioned: myofascia release for the sole of your feet with a wooden dowel works really well (or balls). 

In addition, here are some complementary ideas:

Traction Ankle Dorsi w/ Band https://www.youtube.com/watch?v=JsoDi1QN4yk

Toe extensor stretch https://www.youtube.com/watch?v=h2kaEOd3GcI&feature=share&list=TLtLt27NpW_cI

Traction of Big Toe (just pull toe out and medially) 

Toes-spread-out (abduction) - You can augment this one with a rubber band around your toes as you get stronger.  http://drgraber.blogspot.com/2015/04/toes-spread-out-exercise-tso.html

I hope my post gives you some new perspectives, actionable info and avenues for exploration. Doing something just because an “expert” says so is usually not enough (for me). You need to gain some understanding yourself. 

Best,
Eva

Well summarized Eva.

Yesterday I did a one hour trail walk barefoot and 45 minutes in surburbia. My feet feel amazing today. 

I had a patient today who wore 2cm positive heel shoes that also compressed the toes. She was told they need to be tight to support the toes! No wonder she has pain walking.

Most of my patients freak out when I tell them to go barefoot. They do not realise how good they can feel.

It is so simple that it is hard.

Guys thanks so much for the feedback. I really appreciate the effort you've all put in to helping me out.

Eva, addressing your four points.

1. Environment:
   I have a size US15 foot, which I've now realised is also fairly wide. So I have a hard time finding shoes in general. I spend a fair bit of time in basketball shoes and running shoes for my work, but pretty much don't wear shoes whenever possible otherwise. I probably spend a little too much time in flip-flops though. I've only recently figured out that me feet are quite wide, so my most recent pair of running shoes is a 2E width. This alone made an huge difference, and although I'm sure these shoes are still far from ideal (New Balance Fresh Foam Zante V2), it has really made me aware of how much my shoes have been compressing my toes.
   I've been looking at minimalist footwear for a long while, but have not been able to find anything in my size in a store to try on. So I've been a little hesitant to order anything online. I'll take a look into the brands you've recommended, and maybe I'll just have to take a bit of a gamble on sizing.
2. Function vs Fashion
   I think this issue is a particularly prevalent in basketball shoes, I have not found a single pair of basketball shoes that I can buy in a wider size and measurements like heal-toe drop are never reported. I've been wondering about perhaps wearing a shoe not specifically designed for basketball, the issue is finding a shoe that can handle the lateral stress I put on it (I've busted through the side of more pairs of shoes than I care to remember). As I said above, I'll have a look at the brands you recommended and take a gamble on the sizing online.
3. Othotics
   Yeah I've completely given up on the idea of orthotics. I listened to an interesting podcast a while back talking about how so many of the things we use for comfort and convenience in our everyday life (shoes, chairs, pillows, beds, etc) end up acting like a crutch and over long term use promote serious dysfunction. For me the orthotics did not work at all, but I see so many other players that are completely dependant on them. To a certain extent I'm glad that they didn't work out for me, because I think I've avoided that same fate and it's forced me to seek to fix the issues at a more fundamental level.
4. Mobilize > Strengthen > Integrate > Diversify.
   Thanks so much for the exercises and advice. I've already begun to notice a difference in my mobility just from the front split stuff. Hopefully the combination of that along with these exercises will help to accelerate this process. You mentioned at the start that it will effect my whole kinetic chain. Up until last year, the only issues I had ever had were ankle issues from multiple sprains (and the toe issues I was unaware of), but I think my kinetic chain is now starting to show signs of stress from these dysfunctions. I've developed what feels like Osgood-Schlatter's in my left knee, which has been a bit of a nuisance to deal with. I've also started to develop some lower back issues, which again, I think stem from this toe and ankle dysfunction. The GST training has helped both of these issues immensely.

Thanks again Eva, this was a really awesome post. I'll try remember to fill you guys in on my progress, I'll upload another video a couple of months from now.

On 4/4/2016 at 8:21 AM, Auryn Macmillan said:

I listened to an interesting podcast a while back talking about how so many of the things we use for comfort and convenience in our everyday life (shoes, chairs, pillows, beds, etc) end up acting like a crutch and over long term use promote serious dysfunction.

Do you happen to have a link to that podcast? I've recently been sleeping on the floor a couple nights a week and while I wake up stiff, after a short limbering I feel more awake and refreshed than I do after sleeping in a bed. I've also made the switch to barefoot minimalist shoes over the past 8 months or so and I'm loving it. I'm interested in learning more about the effect of removing these unnoticed crutches from our lives.

4 hours ago, Ian Gibson said:

Do you happen to have a link to that podcast? I've recently been sleeping on the floor a couple nights a week and while I wake up stiff, after a short limbering I feel more awake and refreshed than I do after sleeping in a bed. I've also made the switch to barefoot minimalist shoes over the past 8 months or so and I'm loving it. I'm interested in learning more about the effect of removing these unnoticed crutches from our lives.

I was episode 601 of the Joe Rogan Experience with Katy Bowman. 

https://vimeo.com/116839741

Interesting that you're sleeping on the floor. I've not yet worked up the courage to risk my night's sleep out of bed. Must try it some time soon. What kind of floor are you sleeping on (carpet, wood, tiles, etc)?

Auryn ditch the flip flops or add a heal strap to them so that you aren't constantly gripping with your toes to keep them on.

1 hour ago, Ryan Reynolds said:

Auryn ditch the flip flops or add a heal strap to them so that you aren't constantly gripping with your toes to keep them on.

I'll ditch them and just go barefoot. Luckily I'm living in a tropical climate right now, so should be easy to manage.

On 4/5/2016 at 5:08 PM, Auryn Macmillan said:

Interesting that you're sleeping on the floor. I've not yet worked up the courage to risk my night's sleep out of bed. Must try it some time soon. What kind of floor are you sleeping on (carpet, wood, tiles, etc)?

It's mainly been laminated wood or carpet with varying thickness of padding underneath. Most schools/churches don't care about having super soft floors. If I'm lucky I can snag a panel mat. Typing this I've realized this isn't really a recent thing. I did this about 50 nights/year for 4 years. It's after taking a year long break that I noticed the stiffness. 

I listened to that podcast and it was very interesting. Thanks for the link. 

Auryn:

You might also try the New Balance minimus series.  I wear a size 13 (U.S.) and have had almost no difficulty ordering them on-line.  I wear them every day for work and for workouts.  I've gone through 5 or 6 pairs in the last 4 years.

I also played basketball for a long time, including at the collegiate level.  If you are still playing, you might consider the good ol' Converse Chuck Taylor -- it has almost no toe/heel drop.  You'll have to try them in limited doses at first, until your ankles are strong/flexible enough.  My brothers and I used to wonder how my dad (who also played collegiately in the early 1960s) could have worn Chuck Taylors and not gotten a thousand ankle sprains.  The answer, of course, is that he had strong/flexible ankles BECAUSE he wasn't wearing a modern basketball shoe.

Great points from Eva and Mark here regarding the toe.  

I just want to chime in on the ground sleeping.  I am a big fan.  Unfortunately my wife is not, so I just really try to sleep on the ground when I can.  Camping, out of town, any excuse to sleep on the floor I will do it.  If you do it regularly you won't be sore.  It does leave you feeling refreshed.  It actually helps with back and spine mobility, as you're basically stretching all night long.  Most aboriginal cultures sleep on the ground, hard/soft/cold/irregular.  very interesting stuff, but no good science on it unfortunately.  

Good luck on the toe, I'm confident with continued maybe daily work it will improve.

I am trying to convince my wife we need a futon. She thinks sleeping on the floor is what dogs do. I don't use a pillow, so at least my neck gets stretched all night.

curious about the sleeping without a pillow.    wont that force your neck to be hanging off the cervical spine joints all night as there is meant to be a bit of a natural curve in the neck?  ive slept without pillows many times before camping and what not but i find a small pillow with a bit of support under the neck feels a lot better when sleeping.  

8 hours ago, Andrew Long said:

curious about the sleeping without a pillow.    wont that force your neck to be hanging off the cervical spine joints all night as there is meant to be a bit of a natural curve in the neck?  ive slept without pillows many times before camping and what not but i find a small pillow with a bit of support under the neck feels a lot better when sleeping.  

I use to think the same. I actually advised my patients on finding a pillow that supported the neck so it did not side bend. 

Read this article for a good summary of how using a pillow is like wearing an orthotic.

https://nutritiousmovement.com/your-pillow-is-an-orthotic/

interesting article. I find sleeping on the ground more comfortable than a bed and always have better night sleeps on the ground but without a pillow i have always struggled to get to sleep.  my pillow is probably only the equiv height of a rolled up shirt and the longest i've ever slept without a pillow was 2-3 weeks i think.  I will try it again and see how it goes especially with the TSs once a week. I have also been barefoot walking as a child and now again as an adult for the past 5 years.  my feet are super strong but definitely need to work on the rom in my ankles which is actually quite terrible( supremely tight soleus and Achilles).  

anyway sorry for the hijack and thanks mark.

I found that I would fall asleep without a pillow and then if I woke in the middle of the night with soreness in the neck I would use the pillow. As my neck adapted I needed the pillow less. Even now I feel like I need a pillow, but it is psychological.

my issue is just being able to fall asleep without a pillow.  dont know why but my mind wont drift off unless i have the pillow. I have crazy tight upper traps though not sure if that makes a difference.

I wouldn't want to go to sleep with crazy tight upper traps… Have you tried using an moist heat neck pillow/wrap BEFORE going to bed? Not for sleeping on it though. Most have flax seeds or a combination of relaxing/healing herbs. 
http://www.amazon.com/Natures-Approach-Aromatherapy-Shoulder-Herbal/dp/B00M1TSBJK/ref=pd_sim_121_4?ie=UTF8&dpID=518WJCsoKoL&dpSrc=sims&preST=_AC_UL160_SR160%2C160_&refRID=15R778D0XSKGHJ8D842Q
I'm sorry about the cursi fabric design, but I've convinced some of my male clients to get one. One of them (picture hockey player) even took it on a weekend trip. His girlfriend found the pillow in his suitcase and she was like: "what's this??" – "um-hum, nothing" he said. I was laughing SO hard when he shared that story… 

Also, if you have a good quality foam roller and know proper techniques, rolling around your upper traps and back corners of neck works well.

I usually sleep without a pillow when lying on my back, but tend to "need" one when lying on my side. Do you guys find the same? If not, what kind of a position do you end up laying in on your side in order to get comfortable?

ice pack tends to work sometimes for me.  I used to do some rolling but i realised the main culprit is weak lower traps a long with tight over powered pec minor, which im working on.  need to start rolling again but i find it really hard to hit the right spots some times.  with all this gst training and climbing though you run out of time to do it all.

On 14 April 2016 at 9:45 AM, Andrew Long said:

my issue is just being able to fall asleep without a pillow.  dont know why but my mind wont drift off unless i have the pillow. I have crazy tight upper traps though not sure if that makes a difference.

This will make a difference. Why are they tight? What do you do in the day time that would make them tight?