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The importance and structure of the toes and prehab tips and exercises for athletes

The toes consist of multiple osseous and soft tissues including tendons, nerves, and ligaments, that support our body weight.   Each toe has multiple small bones called phalanges that connect to metatarsals, the longer bones in our midfoot.  Each toe is made up of three phalanx bones- the proximal, middle and distal, except for the big toe which only has two phalanges, the proximal and distal.  The main function of your toes is to provide posture and balance, support our body weight, and propulsion during the gait cycle.  Not only do your toes help thrust your body forward when you walk, they actually help increase the length of your stride allowing you to run faster.

Most common issues occurring in the toes and their joints in athletes

The most common issues I see affecting the toes and joints of athletes include painful hammertoe deformities and associated corns, calluses, and runner’s nails.

Hammertoes -Hammertoes are contractions of the toe caused by a muscular imbalance in the foot where the tendons on the bottom of the foot over power the tendons on the top of the foot.  As the toes contract they may become permanently bent in a flexed position. This deformity often causes pain when wearing closed toe shoes when the bent toe begins to rub against the top of the shoe. The friction can cause a corn to develop. 

Corns and calluses- As you age, the fat pad underneath your foot also becomes thinner leading to a condition known as fat pad atrophy. As the skin loses this underlying protective padding, the formation of painful calluses because the skin lies between a bony prominence inside the foot and the shoe or weight bearing surface on the outside. Essentially the skin lies between a rock and a hard place and this can become very painful.  Corns are essentially painful calluses that occur on the top or sides of the toe as mentioned above, because of underlying hammertoe deformities that cause the skin on the top or side of the toe to become painful and thickened as the contracted toe rubs up against the shoe or adjacent toe..

Runner’s nails-One of the biggest mistakes my patients make prior to any marathon is to not trim their toenails as short as possible.  By not doing so, they can experience black toenails that will eventually fall off, cause blistering and bruising.  Black toenails are caused by repetitive microtrauma to the nail plate subsequently resulting in small blood vessels bleeding underneath the nail plate forming a bruise known as a subungual hematoma.

Prehab or rehab exercises recommend to care for toe function and mobility

A few exercises I recommend for toe function and mobility are:

Toe Curls

1. Sit barefoot in a chair comfortably 
2. Place a towel or a few marbles on the floor and put the upper half of your foot on the towel or marbles. 
3. Keep your heel down on the ground and crunch the towel/ marbles up with your toes. 
4. Relax your toes and repeat 10 to 12 times.

Toe Taps

Taps can be done from the same position as toe crunches.

1. With bare feet, extend your great toe downward while extending your remaining toes up in the air. 
2. Hold this position and lightly tap the floor with your great toe. 
3. Do 10 to 12 taps and then reverse your toe position so your great toe is pointing upward and your lesser toes are pointing downward. 
4. Repeat the same taps.

Toe Stretches

You can also stretch your toes with the use of a towel to help elongate the muscles.

1. Sit on the floor with your legs straight out in front of you. 
2. Wrap a towel under the toes, gently pull up the ends of the towel towards you with your hands and hold this stretch for 20 to 30 seconds. 

Toe Rolls

Toe rolls are similar to when you tap your fingers from side to side on a table.

1. Stand barefoot on a flat surface. 
2. Lift all of your toes together off of the ground and then roll them down one at a time from one direction to the other and then back again. 
3. Repeat this movement 10 to 12 times in both directions.

5. Toe Squeezes

The squeeze exercise can be performed from a seated position.

1. Place your foot comfortably over your opposite thigh. 
2. Slide your fingers in between your toes and squeeze your toes together, pinching your fingers. 
3. Release and repeat 10 to 12 times. 

Other Treatment Interventions

If hammer toe exercises are effective for treating your deformity, other interventions can help. Assess your footwear and avoid any shoes that have a narrow toe box — the front of the shoe where your toes reside. Your shoes should be one-half inch longer than your longest toe. Generally, this is about the size of the tip of your index finger if you have small hands or pinky fingers, if you have large hands.  Another technique to determine whether your shoes are appropriately sized, is to trace your foot onto a piece of paper at the end of the day when your feet are most swollen. Then place the shoe over the tracing of the foot. If the tracing of the foot is external to the periphery of the shoe then you know that your shoes are too narrow.  I recommend buying your shoes at the end of the day when your feet are most swollen.  If your shoes are comfortable at the end of the day when your feet are in their worst shape, then they will feel comfortable through the day.  Overall in mild cases of hammertoe deformities, I recommend the use of hammer toe pads, toe spacers, toe socks, custom orthotics, and wider shoe gear can help.  In severe cases, surgery is also a viable treatment option.

Toe-directed tools that you find have merit for athletes?

Toe spacers

Hammer Toe pads

Toe socks

Custom Orthotics

Athletic shoes with a wide toe box