When the Great Toe is in a Jam
Turf toe. Sesamoid injury. Great toe sprain. Hallux limitus. All these terms refer to a sprain of the big (or first) toe. The joint at the end of the first toe is called the metatarsophalangeal joint (MPJ). Sprains or jamming of this joint are common in athletes. Therapists at the Healthsouth Sports Medicine and Rehab Center in Florida report the results of a study on treatment for this problem.

The authors looked at 20 patients with MPJ pain, loss of motion, and weakness. Everyone got the standard 12 physical therapy sessions for four weeks. Treatments included heat and/or cold, exercise, and electrical stimulation. Ten patients also had gait training and joint mobilization along with strengthening of the toe flexor muscles.

Joint mobilization is used to help restore joint motion. The therapist moves the joint in a specific direction with a certain type of movement and repetition. In this study the sesamoid bones were mobilized. The sesamoids are two tiny pea-shaped bones underneath the long bone of the foot where it attaches to the big toe.

The authors found that the group who got sesamoid mobilization, gait training, and flexor strengthening did much better. They had more joint motion, greater strength, and lower pain levels compared to the other group.

The authors conclude that the right treatment is important early after hallux limitus. Without proper treatment, the patient can go on to develop chronic pain and loss of function. The plan of care should include mobilization, gait training, and special exercises to strengthen the toe flexors.
Jennifer Shamus, PT, PhD, CSCS, et al. The Effect of Sesamoid Mobilization, Flexor Hallucis Strengthening, and Gait Training on Reducing Pain and Restoring Function in Individuals with Hallux Limitus: A Clinical Trial. In Journal of Orthopaedic & Sports Physical Therapy. July 2004. Vol. 34. No. 7. Pp. 368-376.