4 Points For Big Toe Pain (Part 1)

Big toe (hallux) pain occurs in a significant number of people at some point in their lives.  Not only affecting athletes, hallux pain also includes the sedentary population to a significant degree.  Early assessment and treatment of big toe pain is important in preventing long-term damage and chronic reinjury.

Although hallux pain triggers are various, this article will be focused on pain due to stress and strain on the joint due to the surrounding musculature.  If hallux pain is mainly located on the plantar (bottom) side of the foot, the four points found here may help provide significant relief.  These simple points can be manipulated oneself or treated by a skilled massage therapist or licensed acupuncturist.

Point 1 –  Abductor hallucis muscle.  This muscle is responsible for plantar flexion of the hallux and some medial deviation (hallux varus) of the proximal phalanx (big toe points away from other toes).  The abductor hallucis gives structure to the medial arch of the foot as well.  Tight abductor hallucis muscles can be easily mistaken for plantar fasciitis pain.  A notable distinction is that this pain is typically concentrated along the medial arch of the foot between the 1st metatarsophalangeal joint and the calcaneous (heel).  [See Figure 1 for treatment location.]

Point 2 –  Adductor hallucis muscle.  Compared to abductor hallucis, this muscle similarly plantar flexes the big toe, but laterally deviates (hallux valgus) the proximal phalanx (big toe points toward other toes).  The opposing forces of the adductor hallucis and abductor hallucis provide stabilization of the hallux in the transverse plane.  Severe lateral deviation of the proximal phalanx is sometimes referred to as a bunion. The adductor hallucis pain is typically concentrated on the lateral edge of the 1st metatarsophalangeal joint and can spread to an area beneath the 2nd through 5th metatasophalangeal joints. This muscle is considered a deep foot muscle and will require adequate pressure for stimulation.  [See Figure 1 for treatment location.]

Point 3 –  Flexor Hallucis Brevis muscle.  The flexor hallucis brevis shares some of the function of both the abductor and adductor hallucis muscles.  Pain caused by the flexor hallucis brevis is mainly located around the 1st metatarsophalangeal joint.  This muscle is considered a deep foot muscle and will require adequate pressure for stimulation. [See Figure 1 for treatment location.]

1 - Abductor hallucis; 2 - adductor hallucis; 3 - flexor hallucis brevis

(Figure 1)  1 – Abductor hallucis; 2 – Adductor hallucis; 3 – Flexor hallucis brevis

Point 4 –  Flexor Hallucis Longus muscle.  This muscle is located outside the foot and is thus known as an extrinsic foot muscle.  It resides in the lower leg behind the soleus muscle and attaches to the fibula.  The flexor hallucis longus is a comparably large plantar flexor of the hallux and is thus responsible for strong plantar flexion of the big toe, especially during walking and running.  This muscle is one of the most important muscles to treat in big toe pain and due to its remote location, one of the least addressed.  Since this muscle is deep to the soleus, adequate pressure is necessary for proper treatment of the flexor hallucis longus.  [See Figure 2 for treatment location.]

Figure 2 - Flexor Hallucis Longus

(Figure 2) 4 – Flexor hallucis longus

In any painful foot condition, treat the musculature and soft tissue first.  Tight muscles will continuously pull on joints and elicit pain.  This common occurrance is often overlooked in sourcing joint pain.  Intolerance to orthotics may be a sign that the muscles in the foot are causing pain or problems associated with the big toe and foot.  Before seeking out orthotics, one should have the surrounding musculature checked for tender trigger points and sensitivity.  Orthotics typically solve structural problems of the foot and should not be used until all of the functional components (i.e. muscles, tendons, fascia) have been treated for some length of time.  Calf cramps, foot cramps, poor circulation in the lower extremities are other signs that muscular problems in the feet are occuring.  This functional approach to medicine can save hundreds to thousands of dollars in expenses and can circumvent more invasive procedures, such as surgery.

A simple, effective tool in maintaining the functional ability of the hallux is a rubber ball.  Roll each foot over a ball for 5 minutes a day, spending a minute or more on each of the points listed above.  Sit on the floor with legs straight out and place the ball under #4.  The weight of the lower leg may provide enough pressure to stimulate the flexor hallucis longus.  If not, cross the other leg over top of the leg being treated to increase the weight.  This procedure should be followed 4-5 days a week for a couple of months to allow the muscle spasms and tightness to abate.  This is an excellent way to promote good blood circulation, massage intrinsic foot muscles, stimulate nerve endings, and refresh tired, worn out feet.

August Point Wellness offers a self-massage tool called the Sciaticare Ball that is quite a bit more useful than the rubber ball stated previously.  The Sciaticare Ball can be used on feet, calves, back, hips, and much more.  With an easy to place handle, it allows better control in massaging those hard to reach places.  Visit www.augustpoint.com or Amazon to purchase.  As always, for best results, seek out the guidance of a licensed massage therapist or acupuncturist and combine professional treatment with self-treatment for optimal health.

Related links:

Big Toe Pain…And Gout is NOT the Diagnosis

Why a Pregnant Woman Should Massage Her Soleus Muscles

A pregnant woman

Soleus Muscle Massage is Good For Mother and Baby

Pregnancy can be tough on the body.  Although a woman’s body is made to nurture and carry a fetus for 10 months, it does not mean that the task is easy.  Her physical structure will change to accommodate the additional load in the front.  The mother’s joints will become more relaxed and flexible to distribute the extra weight.  Her blood supply increases by approximately 30-40%.  Increases in breathing rate and cardiac output provide ample oxygen to both mother and growing baby.

With the increased need for cardiac output, the heart works harder to pump blood throughout the mother’s body as well as the fetus.  Keeping the circulation vessels (arteries, veins, capillaries) relaxed, open, and clear ease the heart’s pumping obligations.  Managing bodyweight, keeping an adequate fitness level, and maintaining a healthy diet are three things that are recommended before and during pregnancy to help a woman reduce her cardiovascular burden.  But, something that can greatly improve cardiovascular efficiency and reduce vascular resistance is soleus muscle massage.

The soleus muscles are large flat muscles of the calves located between the posterior knee and heel.  They lie underneath the gastrocnemius at the superior end and tie into the Achilles tendon at the inferior end.  The soleus muscles are situated adjacent to the deep veins that help transport blood back to the heart.  When the soleus contracts during walking, running, or jumping, it acts as a pump for venous blood returning to the heart.  The soleus is such a powerful pump, it has been dubbed the ‘second heart’.

Muscles of lower extremity

Muscles of lower extremity (Photo credit: Wikipedia)

The importance of the soleus muscles in pumping blood cannot be understated.  If they are strong, supple, active, and functioning to capacity, the soleus can synergistically work with the heart and pump blood efficiently throughout the pregnant woman‘s body.  But if the soleus muscles are tight and/or in spasm, the heart does not get the extra assistance.  Unfortunately, the heart will then work alone and be forced to pump that much harder.  Additionally, tight soleus muscles can restrict blood flow significantly and lead to swelling, edema, high blood pressure, varicose veins, phlebitis, posterior compartment syndrome, increased breathlessness, and other complications.  Tight soleus muscles can also trigger low back pain, which can amplify pregnancy related lumbago.

Treatment of soleus muscles should ideally be sought throughout the entire pregnancy.  Acupuncture and massage therapy are two drug-free solutions that can provide marked results while also giving the mother-to-be a chance to relax during treatment session.  With regular treatments, a woman can reduce lethargy and fatigue, improve emotional state, minimize painful edema and swelling, lower blood pressure, reduce back pain, lower respiratory exertion, and improve her overall state of being.

A sample treatment at our clinic would be:

The Soleus Muscle, The Second Heart

Deep and superficial layers of posterior leg m...

Soleus

The heart is an amazing organ that pumps between 5 and 7 thousand liters of blood a day.  Yet, it is not the only pump in the body.  While the heart pumps blood out towards the extremities, deep muscles assist in pumping blood back towards the heart.  One of the most important muscles for assisting blood flow back to the heart is the soleus muscle of the calf.

The soleus muscle is a large flat muscle in the lower leg.  Part of the soleus can be palpated directly, while the rest lies underneath the gastrocnemius muscle.  The location of the soleus muscles are important.  They are on the extreme distal end of the body and furthest away from the heart.  When standing upright, the soleus resides at the body’s lowest gravitational point.  These two factors put the soleus in an ideal position to work synergistically with the heart as an efficient pumping system.  The heart pumps arterial blood, while the soleus pumps venous blood.  But, this occurs best when the soleus muscle is healthy and supple.

Problems with the soleus are a frequent cause of pain and suffering.  Athletes and inactive people can both be affected.  This happens because the soleus is used in many activities, such as walking, running, and cycling.  It is a hardworking muscle that tends to get heavy use and very little care.  Most people don’t take enough time to stretch and treat the soleus.  Hence muscle tightness and trigger points can form, causing the soleus to hinder circulation rather than help.

Tight, stiff soleus muscles can radiate pain to the heel, ankle, and as far away as the lower back.  Complications from soleus tightness include:  ankle instability, calf cramps, varicose veins, phlebitis, lower leg edema, low blood pressure, orthostatic hypotension (postural hypotension), and hypersensitivity of lower back.  Pain that is mimicked by tight soleus muscle include:  plantar fasciitis, heel spurs, stress fracture, shin splints, Achilles tendonitis, and thrombosis.

Treatment for the soleus muscle should begin with natural therapy.  Home treatments such as strength training, stretching and self massage should be done regularly to maintain the muscle’s pliability, density, range of motion, and function.

At August Point Wellness, we believe that many of the soleus muscle issues can be addressed through acupuncture, massage therapy, and stretching.

An example treatment that we would use to address tight soleus:

Inversion Ankle Sprain – Why Treat the Muscles If I Twisted My Ankle?

Any athletic activity requiring footwork allows for the potential of ankle injury.  Even walking doesn’t remove one from the chance of twisting an ankle.  For those that injure an ankle, treatment should be administered as soon as possible.  Improper treatment, or lack thereof, can cause poor healing and leave the ankle more susceptible to repeated injury.

First, let’s analyze the lower leg and foot.  The muscles that move the ankle are located in the lower leg.  These muscles are called extrinsic muscles of the foot, since they control the foot from outside of the foot itself.  The gastrocnemius, soleus, tibialis anterior/posterior, peroneus group, etc. are incredibly powerful muscles and help one to walk, jump, and run.  These large muscles in the lower leg are responsible for the gross motor movement of the ankle and foot.  The muscles in the foot, or intrinsic muscles, are responsible for finer movements.  These intrinsic muscles play a large part in supporting the arches of the feet, providing movement for the toes, and relaying spatial information.

Both the extrinsic and intrinsic muscles relay information to the brain about proprioception, or spatial positioning.  This idea is important, because after ankle trauma, such as an inversion ankle sprain, the “sensors” which send proprioceptive signals back to the brain can be injured.  During the actual ankle inversion injury, tendons and ligaments can get stretched.  The body reacts to these rapidly stretched sinews by strongly contracting musculature supporting the ankle.  Why?  It’s an inherent protection mechanism from further damage.  By tensing the muscles around the ankle, the body tries to avoid possibility of more violent damage.  The chance for reoccurence of injury is when these proprioceptive sensors do not return to normal function after trauma.

So, now, the injury is here.  The soft tissues around the lateral malleolus are swollen, bruised, and stretched.  Some people will apply ice to reduce swelling.  Some will apply heat.  (We’re not going to go into the ice vs. heat argument here.)  But, many will do no more than administer thermal treatment and believe that time and “walking it off” will fix everything.  Poor rehabilitation methods can leave the tendons and ligaments damaged and stretched.  They can also leave the muscles in spasm, thereby giving the person a feeling of weakness and instability in the ankle.

Since the scope of this article is treatment of musculature for ankle injury, discussion of the mechanics of injury and other forms/areas of treatment will not be found here.  But, the reader should note that this article focuses on treatment of the muscles of the lower leg and foot.  The ideas found here are extremely important when rehabilitating any type of ankle injury and can be applied to any treatment regimen.

What muscles should be treated in the case of an inversion ankle sprain:

  1. Peroneus Group – The peroneus muscles of the lower leg are made up of 3 (and sometimes 4) muscles.  These muscles are also called Fibularis (longus, brevis, tertius, quartus) and run down the lateral side of the lower leg.  They are generally responsible for dorsiflexion and eversion of the foot.  Basically, when you “roll your ankle” these muscles try to pull your foot back to a neutral position.  Pain from these muscles are located  anterior, posterior, and inferior to the lateral malleolus.  If you are still having pain in these areas well after your ankle sprain, look to treat these muscles.
  2. Anterior Tibialis – This muscle is located on the front of the lower leg and is heavily used in foot activity.  The job of this muscle is to dorsiflex the foot with some slight inversion.  It has a tendency to be tight and easily fatigued from overuse.  Pain from tight anterior tibialis can be felt on the anterior portion of the ankle and in the big toe.  If there is pain on top of the ankle well after the ankle sprain, look to treat this muscle.
  3. Extensor Digitorum Longus – The EDL muscle aids in dorsiflexion and eversion of the foot.  This muscle assists the peroneus group in their function.  It is located underneath and slightly lateral to the tibialis anterior muscle.  Due to its deep position in the foot, it is sometimes missed during treatment.  Pain in the anterior portion of the foot can be caused by tightness in the extensor digitorum longus.
  4. Extensor Digitorum Brevis/Extensor Hallucis Brevis – These are two intrinsic muscles of the foot that should be treated after inversion ankle sprain.  These muscles are located on the top of the foot, just anterior to the ankle joint.  They dorsiflex the toes and you can usually see them contract when doing so.
  5. Other Supporting MusclesSoleus, gastrocnemius, flexor digitorum brevis, are other muscles that can also be treated during a rehabilitation phase of ankle sprain.

Why should one treat the muscles in an inversion ankle sprain?  As stated earlier, the “sensors” that tell the brain one’s orientation in space can be damaged in an ankle sprain.  When these proprioceptive sensors are injured, the brain can get mixed signals as to where the foot is, relative to the body and to the ground.  It is important to give these sensors (or stretch receptors in the muscle) the best opportunity to “unstretch” or return to normal function and sensibility.  By treating the muscles surrounding the ankle, these proprioceptive signals can reset themselves and bring back the kinesthetic awareness of the feet.  Another reason for treating lower leg muscles would be to reduce/prevent inflammation of the tendons as they pass over the and around the ankle joint.  The abnormal tension due to tight musculature in the calves can increase the stress on the ankle joint and cause tendonitis.

Treatment of the lower leg and foot musculature along with the damaged ligaments and tendons should be initiated soon after trauma occurs.  Alternative and complementary medical care such as acupuncture and massage therapy are beneficial as both can reduce recovery time and assist in the healing process.  Alternative treatment modalities can also provide effective, drug-free, natural care, which is easily incorporated into any Western medical recovery program, if necessary.

A sample treatment of ankle sprain that I may use in my clinic would be:

  • Acupuncture – LV3, SP10, Peroneus longus/brevis/tertius Motor Points (MP), ST36, Anterior Tibialis MP, Extensor Digitorum Brevis MP, Extensor Hallucis Brevis MP, Soleus MP.
  • Massage Therapy – Lower Leg Tui Na and Massage for Posterior and Lateral portion of lower leg.
  • External Liniment/Rub – San Huang San poultice during first 2-3 days after injury.  After first 72 hours, Sciaticare Penetrating Muscle Rub applied over  muscles as well as over swelling and inflammation.  Patient would apply Sciaticare PMR daily and massage into area to promote circulation and healing.  Application of Sciaticare PMR before any rehabilitation exercises would be recommended as well.

Notes:  Attached are a couple of video links showing some simple self-massage and tui na techniques to assist you in the rehabilitation of your inversion ankle sprain.

Disclaimer:  If you need to seek outside medical attention, please do so.  A second opinion couldn’t hurt.

Big Toe Pain…And Gout is NOT the Diagnosis.

Dorsal and plantar aspects of foot

Image via Wikipedia

The big toe (hallux) is vital to ensuring humans continue to walk upright.  The strongest of all of the toes, it is also the largest one on each foot.  Needless to say, the halluces are probably the most important toes of all. Problems that can occur with each hallux may cause numbness, tingling, weakness, stiffness, etc., in and around the area of the big toe. With any combination of these symptoms, walking upright can become difficult.

If you think gout is the only reason for a painful big toe, think again.  Before you decide that your diet needs adjusting and you need a full blood panel done, first address the musculature supporting the hallux.  There are seven important muscles that attach and provide movement to the big toe.  Flexor hallucis longus, flexor hallucis brevis, extensor hallucis longus, and tibialis anterior are all extrinsic (outside foot) hallux muscles.  Extensor hallucis brevis, abductor hallucis, and adductor hallucis are the three intrinsic (inside foot) hallux muscles.  I’ve also included an eighth muscle, tibialis posterior, as one that can cause pain in and around the big toe although it doesn’t have a tendinous attachment to the hallux bones as the other muscles do.

On the underside of the foot, at the base of the big toe, a tight adductor hallucis may exhibit pain in this area.  Both flexor hallucis longus and brevis can cause pain and numbness in the underside of the big toe.  Abductor hallucis usually causes pain on the inside of the heel, and if this muscle is tight enough, there is accompanying pain beneath the first metatarsal.  Tibialis posterior can cause pain at the base of the big toe, but this muscle may also show pain in the Achilles region of the lower leg.

If the top of the hallux is painful, the muscles that dorsiflex (or extend) the big toe could be the offending party.  The muscles that dorsiflex the big toe are the tibialis anterior, extensor hallucis longus, and extensor hallucis brevis.  Tibialis anterior will generate pain or tenderness in the shin as well as pain on the dorsum of the foot.  Pain caused by the extensor hallucis longus may be felt in the front of the ankle as well as on top of the big toe.  Extensor hallucis brevis will only cause pain in the location of the muscle, at the top of foot near the base of the first metatarsal.  Check all three of these muscles when pinpointing the cause of your toe pain.

To treat your stiff, tight, aching muscles, seek out your favorite acupuncturist and/or massage therapist.  Also, try a warm foot soak in Epsom salt to help relax muscles further.  Follow up your foot soak with easy stretching for both the intrinsic and extrinsic foot muscles.  In conjunction with professional care, you can self-treat your muscles with the Sciaticare Ball by August Point Wellness.  Roll your foot over the Sciaticare Ball to treat the acupressure and trigger points on the underside of the foot.  Rolling the entire plantar side of your foot will do wonders to treat the many small, hardworking muscles that ache from continued walking, running, etc.  The Sciaticare Ball can also treat the tibialis anterior and can address other extrinsic muscles in the lower leg.  A regular care plan should include visits to your practitioner as well as self-care.  For your self-care, we highly recommend the Sciaticare Ball.  Visit our website to learn more about the Sciaticare Ball and how you can rid yourself of big toe pain.

Related Links:

4 Points For Big Toe Pain (Part 1)