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  ( http://youtu.be/IIyg7ejYNOg ) 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.http://thegaitguys.tumblr.com/post/14766494068/a-case-of-plantar-foot-pain-during-gait-this

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

Short discussion on the toe extensor muscles

We received a great question from a doctor active on our Facebook page (Thegaitguys PAGE, not our user portfolio, make sure you are on the “PAGE”)
Here was the comment:I do like the crouch gaits to help with proximal muscle activation. However I am still not sold on the long toe extensor activation. It would seem to me that the function of this muscle in close chain (ie gait) would be more to aid in pulli…ng the body over the talus (while keeping the toes fully anchored and wide) as opposed to extending the distal phalanx in an open chain fashion. While open chain exercises may ‘strengthen’ this muscle the neurological processing would seem to be different than closed chain and therefore the transfer to more dynamic exercises would be difficult.? I would think that it would not necessarily change the gait but instead allow for better compensatory strength and durability. Although I still have yet to develop a great exercise for this closed chain control. Any ideas?See More

10 hours ago · LikeUnlike

The Gait Guys when you activate the toe extensors the arch is increased from the windlass mechanism across the metatarsophalangeal joints. Raising the arch will help bring it to neutral since the crouched gait is a pronation challenge. give it a try…..…….try the crouch shuffles with toes down and toes up…..you will feel the increased demand on the anterior leg compartment, the greater awareness of the foot tripod esp the first metatarsal head anchor point and the improved ability to control the internal tibial spin (and pronation challenge( that occurs with shuffling with toes down. Remember, closed chain is not any more important that open chain activities……arm swing it gait is open chain but it is necessary…..leg swing is open chain but it is necessary for normal progression and pelvic/core use. also remember……we are a flexor dominant society…..look at how many of your clients toes have either a gentle flexion to them or significant…..the balance of the function across the metatarsophalangeal joint is necessary on balance of extensors and flexors……the shuffle gait with toes up is a huge challenge to the toe extensors……that feeling of the strain on the top of the foot and into the shin is confirmatory. OF course, you are right in what you said……but to get the toes optimally anchored you have to have enough long toe extensor strength to override the long flexor dominance…..otherwise you being hammering the toes and enter into the spiraling vortex of flexor dominance, lumbrical inhibition, short extensor overactivation, proximal fat pad drag etc.