Knee and Hip Pain? Your Big Toe Could Be to Blame

Big toe pain can hobble nearly any athlete. Here's how fix it. Credit: Matthew Antrobus / Getty

Turf toe may make you think of high school football practice, but this little sprain can sideline almost any athlete, at any point. Whether you're a runner, basketball or soccer player, martial artist, or even a dancer, if you push off your feet, you can be felled by this sharp pain at the toe joint. If it's not properly addressed, the injury has long-term implications too.

Turf toe is a ligament sprain of the first metatarsal phalangeal (MTP) joint, also known as your big toe joint, where your foot and toe meet. The big toe plays a crucial role in balance and stability when you walk, jump, and run. As weight is transferred from the heel to the front of the foot, the big toe acts as a lever to allow the foot to push off the ground. An injury to the big toe can alter the entire mechanics of the leg; other muscles will compensate for the toe, which can lead to injuries in your feet, ankles, knees, and hips.

In an ideal world, you use your entire foot when pushing off. Take a look at your feet. Where are your calluses? The location of your calluses will tell you exactly how you use your foot now. If you looked at the feet of one of the most explosive players in basketball, you would see callouses spread out equally throughout all five metatarsal heads (located in your fore foot).

With turf toe clients, I typically see callouses on the medial side (the arch side) of their first MTP joint and big toe, which indicates improper push-off and an excessive rotation force on the first MTP. What this means is the foot is lacking the necessary mobility through the joints. Because of the decreased movement, a turf-toe client is forced to push off through the outside of the foot, causing an excessive amount of rotational force. Over time, this leads to the overextension and sprain of the big toe joint.

In my clinical practice, I’ve found that improper body alignment is the main culprit of turf toe. Pushing off requires the entire posterior chain — the glutes, hamstrings, calves, and foot muscles — to fire, and the opposite anterior chain to counterbalance that force. Improper alignment, like a forward pelvic tilt, can prevent your posterior chain from working properly and sends too much force through your toe.

So if you suffer from turf toe, or think you're at risk based on your calluses, you need to work on getting your body into the right alignment and your posterior chain engaging properly. Here are some simple exercises that will help.

Shin Dorsiflexor Release

  • Find a stable, firm surface roughly knee height. Place lacrosse ball under the front of the shin and kneel onto it.
  • Slowly allow more body weight to sink into ball while your knee continues to bend. Pump your foot up and down until the discomfort in that area decreases.
  • Move ball around to multiple sore spots along to target entire muscle. Perform on both legs for 3 to 5 minutes.

Soleus Release

  • Sit on the ground with your lower calf on top of a lacrosse ball or foam roller.
  • Place your other leg over the one you're releasing to add pressure, and roll yourself up and down over the ball.
  • Once you find a spot that is tender, stop and point your foot up and down for 30 seconds.

Big Toe MWM

  • Stand with one foot in front and one foot behind you. Most of your weight should be on the front foot.
  • Place a resistance band, anchored behind you, around your front ankle.
  • While keeping the entire front foot in contact with the ground, slowly rock your front knee forward while forcing your knee outward.
  • Rock forward as far as you can, but don't let the heel rise off the ground. Return to the starting position. Repeat for three sets of 10 reps on each leg.

Banded Single Leg RDL

  • Stand with all of your weight on one foot, and a resistance band just under your kneecap on your standing leg, anchored so that it pulls your knee inward. Knee should be slightly bent, weight through the heel, shoulder blades down and back with arms in the shape of a W.
  • Force your knee out and extend your non-standing leg straight behind while simultaneously bringing chest forward toward the ground, hinging from the waist.
  • Hold and repeat for three sets of 10 reps on each leg. Do not rotate hips (should be parallel to the ground, keep back flat.)

Nose to Wall With Trunk Rotation

  • Stand on one foot with toes turned in, other foot is down behind you like a kickstand. All of your weight should be on your front foot.
  • With a soft bend in your front knee, shift weight from heel to ball of the foot, while keeping your back foot planted.
  • Make sure chest is up throughout the exercise. Repeat for three sets of 10 reps on each leg.

David Reavy is a Chicago-based physical therapist who works with NFL and NBA players and everyday guys.