The case of the missing toes.

OK, a bit dramatic but as you can see in the plantar view above, all you can see is the toe pads, the rest of the digit shafts are hidden.  

This is a classic example of a foot imbalance. We have talked about this many times before but the attached video link here  ( ) shows it very well.  Read on.

There is shortness and increased resting tone in the short toe extensors (EDB, extensor digitorum brevis) and long toe flexors (FDL=flexor dig. longus) with insufficiency in the short flexors and long extensors. This pairing creates a hammer toe effect.  In the video, you can see that these toes are showing early hammering characteristics, but not yet rigid ones. The key word there is, “yet” so this is still a correctable phenomenon at this point.  You can also clearly see the distal migration of the metatarsal fat pad. The fat pad has migrated forward of the MET heads and is being pulled forward by the excess tension in the long toe flexors. As this imbalance in the toe flexors and extensors develops, the forefoot mechanics get impaired and the lumbricals (which anchor off off the FDL) become challenged. Their contributory biomechanics, amongst other things, help to keep the fat pad in place under the metatarsal heads. You can see in this video link above that by proximally migrating (towards the heel) just the fat pad back under the MET heads the resting mechanics of the toes changes, for the better.  

Remember the other functions of the lumbricals ?  their other major functions, namely: thinking from a distal to proximal orientation (a closed chain mode of thinking), they actually plantarflex the metatarsal on the fixed phalynx, assist in dorsiflexion of the ankle, and help to keep the toes from clawing from over recruitment of the flexor digitorum longus.

Here is another blog post we did on a similar presentation.

Proper balance of the toe flexors and extensors, and their harmony with lumbricals and fat pad amongst other things will give healthy long flat toes that can help the proximal biomechanics of the foot.  If you have neuromas, metatarsalgia, hammer toes, claw toes, migrating toes, bunions or hallux valgus amongst many other things, this might be a good place to start.   

There are exercises that can help this presentation, but understanding “the why” is the first step.

Shawn and Ivo

The Gait Guys

Podcast #30: Running your heart out ?

podcast link:

iTunes link:

Gait Guys online /download store:

other web based Gait Guys lectures:   type in Dr. Waerlop or Dr. Allen  Biomechanics

Today’s show notes:

Neuroscience Piece:

1. Nanosponges could soak up deadly infections like MRSA from your bloodstream

2. iPhone-controlled bionic hands allow father to hold daughter’s hand for first time since accident

3. The science behind Obama’s BRAIN project.

4. Blog reader asks:
I’ve noticed that I’m developing some calluses – on the outside of my big toes. They don’t hurt normally but if I walk for awhile or run a few miles, those (I’m assuming) calluses really starts to ache. Any suggestions for what I can do to help with that?

5. FACEBOOK readers asks:
Hello, I am new to “The Gait Guys,” and was wondering if you have done any blogs about Morton’s Neuromas and bunion treatments. I’m looking for ways other than surgery to fix this ailment. I would love to be able to run and exercise again. Thank you.

6. What Cardiologists Tell Their Friends
“Go easy with the exercise”

Mo Med. 2012 Jul-Aug;109(4):312-21.

Cardiovascular damage resulting from chronic excessive endurance exercise.

7. Brisk Walking Equals Running for Heart Health: Study
By Steven Reinberg

8. Shoes:

9. Runners Can Improve Health and Performance With Less Training, Study Shows

10. A Lesson in Neurology from Jimi Hendrix

by ;luke barnes

Foot Arch Question: Sent in from one of our readers

How would one go about “rebuilding” their transverse arch? The latter is pretty much convex. This also accomapnied by very tight long toe extensors (as evidenced by their tendons being very prominent at the top of my foot and my toes being curled at rest) and have suffered on and off from Morton’s neuroma. The ball of my shoes (right in the middle) is where the insoles of my shoes see the most wear. It’s not a huge concern of mine, but I would like to deal with this. I’ve suffered several ankle injuries (as a basketball player) and although I’ve tried orthotics in the past (for the neuroma), I’ve relied mostly on minimalist footwear (except when playing ball of course…). I know some rehab would be in order and would likely work. I’ve “reconditoned” my big toe abductors in the past and can even cross my second to over my big toe, so am just looking for some direction.

Our Response:

As you probably are aware, there are 3 arches in the foot: the medial longitudinal (the one most people refer to as the “arch”, the lateral longitudinal (on the outside of the foot) and transverse (across the met heads).

Your collapsed transverse arch seems like it may be compensated for by a rigid, probably high medial and lateral longitudinal arches. This creates rigidity through the midfoot (and often rear foot) and creates excessive motion to try and occur in the forefoot. Depending on how much motion is available, this may or may not occur.

You don’t seem to be able to get your 1st metatarsal head to the ground to form an adequate tripod, so you are trying, in succession, to get some of the other, more flexible ones there (thus the wear in the “ball” of the foot you noted). This results in increased pressure, metatarsal head pain, possibly a bunion and often neuromas.

From your description, you actually have very weak long toe extensors (and possibly some shortening) which is causing the prominence of the tendons, along with overactivity of the long flexors (and thus the clawing) in an attempt to create stability. I am willing to bet you have tight calves as well (especially medially, from overuse of the gastroc to control the foot) and limited hip extension with tight hip flexors.

The foot tripod exercises are a great place to start, as well as heel walking with the toes extended and walking with the toes up (emphasizing extension, which counteracts the flexors). Stay away from open back shoes and flip flops/sandals; continue to go barefoot and get some foot massages to loosen things up. Maybe use one of those golfballs to massage the bottom of the foot when you get off the course and get some golf shoes that aren’t quite so rigid.

Hey everyone. Have a Great 4th of July!

The Gait Guys