Our toes traditionally get ignored until they become injured. I mentioned this before and discussed it in more detail in my book. It was brought up yesterday by a colleague so I figured I would post my thoughts.

To begin with, it is simple physics. The wider the base of something, the more stable it is. When we use our toes, they extend and splay making the foot wider in the forefoot. This is where a device called Correct Toes can make a huge difference in those who have a narrow forefoot with adducted digits. Consider what happens with our hands when we do a push up. If we do the push up with our hands made into a fist, it will be much difficult. Our arms will “shake” and be less stable. Yes, it will recruit more muscle contraction which can strengthen the stabilizers of the shoulder, but the point is the muscles have to work harder. This is analogous to the foot where if the base is narrow from the toes being “bunched up”‘, then the foot will be unstable forcing the leg muscles to work harder which can lead to inefficiency and overuse situations. Not as a result of being weak, but because they are at a mechanical disadvantage as a result of the position of the toes.

Strength. Many people do not realize this, but the tendons that flex our toes originate from muscles in the calf. Specifically the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles are calf muscles which not only flex the great toe and lesser toes, but also serve as plantar flexors for the ankle. By simply doing calf raises, you will strengthen these two muscles which will improve plantarflexion as well as make the toes toes stronger to grip the ground during landing. The FHL and FDL are two of the three major muscles (third being the gastrocnemius complex) that plantar flex the ankle as well as play a role in propulsion. When I perform surgery on the Achilles’ tendon in patients who have severe Achilles tendonitis with intratendinous calcifications, the tendon is detached and debrided and the FHL is transferred to the calcaneous (heel bone) to augment the achilles.

I recommend to my patients with plantar fasciits as well as to all runners to perform 100 calf raises a day (Not all at once. They can be broken up into sets throughout the day. I do two sets of 50). They should be done barefoot, and focusing on splaying the toes and gripping the ground. If done with shoes on, the patient has a tendency to get onto the ball of their foot (the first MPJ or great toe joint) and not engage the FDL. This comes in contrast to what Dr. Maffetone recommends. He advises in his new book 1:59, to do higher weights and low reps to avoid fatiguing the muscle and more weight will recruit more muscle fibers. Many physical therapists however, have been advising to do high repetition strength training in order to fatigue the leg muscles as they need to be fatigued. I am still on the fence here. While Maffetone makes sense, I have seen as well as experienced results from the high repetition calf raises. It would be interesting to see Phil’s response to this!

Dr. Nick