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Big toe joint problems lead to painful walking

As a young person, you strode purposefully to your next destination, full of the vim and vigor of youth.

The vitality of that age is manifested in how quickly and powerfully we are able to walk, when our muscles and joints are healthy and undamaged. But the years take their toll, and walking speed generally slows appreciably as the years pass, usually even without any significant trauma.

How many seniors walk as sprightly as they did when they were young?

Sometimes the cause of a limitation in the ability to ambulate is not obvious and may actually be difficult to determine.

Obviously, a pain in some major joint is going to affect how you walk; discomfort will have that effect. But walking is a complex phenomenon, with thousands of changes occurring with each and every step.

The ankle must bend a certain amount, as must the knee, and some of the motion that occurs is not as simple as a hinge-type joint like those.

The foot moves in all three planes of motion, up and down, side to side, and turning in and out. Problems with how the foot is working, which is the foundation for body mechanics, can produce all sorts of problems with gait.

An interesting example of this kind of pathologic change can be seen in the big toe joint, which, it so happens, is a critical part of the ability to walk.

When a person takes a step, there is a point at which the heel comes up off the floor, as the body is passing over the stationary foot. A certain amount of motion at the critical big toe joint is required to walk normally.

What happens when someone can’t bend that toe sufficiently?

You would think that such a situation would be a noticeably painful one, and, indeed, it can be.

This is a unique joint, with a particular mechanism of motion, in which the big toe will “slide and glide” up over the metatarsal bone. To do this properly, the metatarsal bone must be in the right position. If it is not, the base of the big toe will tend to jam into the metatarsal, causing the gradual development of wear-and-tear arthritis.

Early in the development of a stiffened big toe joint, abnormal motion of this joint will cause stress to various structures including the ligaments around the joint, the covering of the joint, even tendons running over and under it.

These can all become inflamed and sore, causing pain in the process.

As stated earlier, pain during gait will alter how someone walks, although the sufferer may be completely unaware that changes are occurring.

They may compensate by turning the foot outward, or perhaps shortening their stride length. But this tends to be a temporary phase, with acute pain from the joint resolving over the years as bony changes occur.

This will often result in a change in the shape of the two bones that come together to make up this particular joint.

This can render the joint completely immobile, even if the foot is off the ground, and one grasps the big toe and attempts to move it.

Generally, this change is accompanied by the growth of extra bone around the joint, and may include the development of spurs pointing away from the joint.

Surprisingly, because the joint is stiff, it is no longer painful, and ceases to be of concern for the individual so afflicted.

It is at this point that some interesting, yet unfortunate, changes tend to occur.

Because of this structural reduction in big toe joint motion, normal gait is impossible. Other changes must take place in this situation. Some of them are anything but obvious, but it is critical to understand that there is a very specific connection between all the parts of the musculoskeletal system.

Any defect which is lasting, and present for years, will cause compensatory changes somewhere else.

Researchers have found that a stiff big toe can lead to jaw pain or chronic headaches.

In the human body, nothing operates independently, and on its own. It is one system, and all the parts are interconnected.

This is the basis for the term “the kinetic chain”, which describes how various structures that are part of this bone-muscle-ligament system, affect the other parts.

Diagnosing this kind of problem can be difficult, especially considering the fragmented state of our medical care.

For example, an oral surgeon, when confronted with someone who suffers from recurrent jaw pain, is unlikely to recognize that the source is the big toe.

A physician specializing in body mechanics is more likely to, but how many people examine their big toe motion, and seek out an appropriate doctor?

Evaluating motion of this joint is certainly something a podiatrist should do on a regular and routine basis.

When someone presents with pain in this structure, many things can be done to relieve the discomfort, from anti-inflammatories, to various wraps and braces. Even using a stiff-soled shoe will help.

But this is a chronic and enduring problem, usually a result of foot architecture that functions poorly, and either their structure must be changed, which means surgery, or we must improve their foot mechanics.

The latter is best achieved with a specialized, in-shoe foot brace, termed foot orthoses. These can be tremendously beneficial when correctly prescribed and don’t have the potential for complications that come with most surgical procedures.

Fabricating an effective orthotic device is a complex and tricky process but can sometimes prevent the degenerative changes which can go on to destroy the joint.

That’s called preventative medicine, which is something our medical system would greatly benefit from pursuing.

So save your joint, and save your cartilage. You’ll walk better as a result.

Dr. Conway McLean, DABFAS, FAPWHc, has offices in L’Anse and Marquette. He is a physician who specializes in treating lower leg, ankle and foot problems.

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