How to treat plantar fasciitis? Lack of big toe flexibility is a major cause of a lot of chronic injuries like plantar fasciitis, heel pain, patellofemoral pain, inside knee pain, hip pain, Iliotibial Band syndrome and low back pain. You need to make sure you have good flexibility of the big toe so you can walk and run properly. If you are missing big toe extension range or the ability to lift big toe up towards your shin, it’s much harder to bring your weight over your foot keeping the foot, shin and knee alignment. In this video I am showing two tests checking for: big toe extension range and plantar fascia tightness. Also, how to breakdown adhesions and loosen up sticky spots along the plantar fascia.

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Transcript:

Hey guys, this is Manu Kalia, physical therapist and Ayurveda herbalist. So I’m going to answer a question that a bunch of you guys have been asking me about foot-related problems, so plantar fasciitis to Achilles tendon issues. And especially for you runners, I got a few of you runners who have asked me this question to go over some key causes of these problems.

So I’m going to go over one major component that I often find is overlooked when looking or assessing for these problems, and not just these foot-related issues but lower leg problems and all the way up the chain, and we’re going to talk about mobility of the big toe and just more specifically your first MTP joint. So we’re talking about this joint right here, which is your metatarsophalangeal joint. So this is right here. So the big toe, this is not the part we’re talking about – this joint here. This is what we’re talking about, this joint right here. How much extension does this joint have? So if you’re lacking extension in this joint, it’s going to impact how you are able to walk and how you are able to run.

So, for example, if I am standing and I’m going to bear some weight through that joint and I shift my weight forward, I need to have enough extension in that big toe. If you pay attention right here, if I’m missing that range of motion in that big toe, what am I going to do? I’m going to work at, as I’m trying to go over I don’t have enough range, I’m going to change the way I move. So I might bring my foot outwards, inwards, more often than not I’m going to bring it outwards. So I might get a little bit possibly even more pronation or over-pronation or possibly a flatfoot position where I’m going to change mechanics all the way up the chain, loading up the tendon differently, more inside knee issues, patellofemoral problems, so all sorts of things, and just reducing efficiency and your performance because I just can’t get over that foot properly.

And a couple of components having to do with that are, one major part first is I’ve got to make sure that I have enough extension in that joint range of motion. So normal is around 80 degrees or so, so I have more than enough range of motion at that joint. So first you’ve got to make sure, do I have enough range of motion at that joint, enough flexibility at that joint, so joint mobility? And the second part is I’m going to see, does the plantar fascia have enough mobility too or are there restrictions along that fascia? So your plantar fascia is this thick band that runs at the bottom of your foot or through this area which is giving your arch support with your muscles, all your foot muscles too as well as big toe muscles. It gives stability to that foot, shock absorption, ability to accept load as well as push off. So if this is too tight, it’s going to change things also up the chain.

So for testing it if the plantar fascia is too tight, we’re going to look at, if I’m going to sit down right here, all I’m going to do is I’m going to shift my weight forward a little bit. So I loaded up the foot, especially that forefoot right through here. Now that forefoot is loaded up and all I’m going to do is I’m going to grab my big toe and I’m going to see if I can raise it up, if I can lift it straight up. How much tension is there as I’m lifting up that big toe? You compare it to your left versus your right side. So in this position, remember as the foot is loaded up, a lot of the restrictive structures are that plantar fascia because it’s too tight. It’s not going to let that big toe come up as easily. Because remember we checked it already, when I am in passive position I had good range, so another structure that could be limiting it is my plantar fascia possibly, possibly some of the other soft tissue and some other structures too. So I checked and I see that, okay, when I bring it forward, load it up and I try to raise it up, I’ve got to get about 30, 40 degrees, so if I can’t and if I’m stuck down here somewhere just can’t even bring it up, then you know once you’re standing and walking and running, you’re loading it up, it’s just way too stiff through there.

So third thing I’m going to do is I get in here and I kind of feel around and I see, do I have any sticky spots? Is it tight somewhere? Is it painful? Is it sore? When I find those spots, those tight spots there, I’m going to use a lacrosse ball. All I’m going to do is put this here and just kind of work at freeing up that tissue. I might go up here, different spots. And let’s say if I find a spot, maybe I find a spot on the inside, and I’m going to work at bearing some weight on it and just roll back and forth or in circular fashion or out through here and just kind of break up the thickening in that, or scar tissue that might be there, free up that tissue, mobilize it—it’s just too hard to stretch that tissue—and that will help relieve some tension also.

For the joint itself you might have to mobilize that joint. That’s a whole other video. And for strengthening and motor control, balance issues with the foot and the muscles, that’s another video. So I’ll post some more of those also for you guys.

Alright, hope you found that useful.