- All right, so big toe pain
or as we call it in the therapy world the great toe.
It's very debilitating Bob, as you know,
and it's oftentimes associated with a limp.
- Yeah.
- We're gonna show you how you can take care of this
with home treatments, and so just hold on,
we'll be right there.
♪ Bob and Brad ♪
♪ The two most famous physical therapists ♪
♪ On the internet ♪
- Okay, big toe pain common causes
and that's what we're mostly gonna cover.
There's a few other ones, but one is gout.
- Sure.
- Gout is a form of--
- Real common.
- Yeah, and from what I've read it's a form of arthritis
but they call it gout and it's usually associated
with a high level of uric acid and crystals.
- [Bob] Yep.
- And for some reason - [Bob] In the joint
- It goes to the great toe. - [Bob] Right
- The big toe joint is a vast majority of time
where it presents itself.
Also bunions, typical arthritis in the toe joint
can happen over time.
And I know I have a friend of mine,
she actually has both of her great toes fused
as a result of--
- A bunion?
- No, just arthritis.
- Really? - Yeah.
- Wow.
- Yeah, absolutely, so we wanna avoid that.
This video doesn't really pertain to stubbing your toe.
- Right.
- With the exception of the first phase,
and you'll understand it in just a second.
So we'll stop. - Let's get to it.
- Oh, we're gonna get to it.
Okay, Bob, we're gonna talk about the acute phase.
In other words--
- Right.
- It's not cute physically, it hurts.
- Right.
- All of a sudden you're--
- It just happened.
- Yeah, it just flared up in the last day or so.
You may not know why, or you know your gout flared up
and you'll know it because here, let's take a look at this.
We're looking at your big toe and it'll be swollen.
It'll be red, painful, when you walk you limp,
because every time you put pressure on it
it's very irritating.
So what you're gonna do is NSAIDs.
If that works for you.
- Non-steroidal anti-inflammatory drugs.
- Often times--
- Ibuprofen. - Ibuprofen
It could be - Aspirin.
- Yep, could be Tylenol.
Whatever works for you and what your doctor allows you.
Make sure you drink plenty of water
particularly if it's gout.
You're gonna elevate if it's swollen,
it's gonna be helpful to in a recliner
or actually laying down elevate with pillows,
your foot above the level of your heart,
that's gonna help reduce that a little bit
and avoid walking and irritating it.
- Yeah, the doctor might give you,
you know a prescription tool.
- Right, right.
And if it is for gout what I've read and heard
is the diet, you know?
- Right.
- And you know, rich--
- Certain foods you gotta avoid.
- Avoid the sugars and all those things
that are inflammatory.
- It is different for different people.
- It is, right.
Next one, address your footwear.
There's a very strong chance
that your toe was irritated by your footwear.
- Yeah, getting squished together.
- Yeah, the toes are too narrow,
you don't have a big enough toe box and you may have a shoe
that you've been wearing for a long time.
And once the swelling starts, that just compounds it
and it gets tighter and tighter and tighter.
So you--
- Very common.
- Yep, so--
- To have too narrow shoes
- Go without a shoe.
Bob and I have just started wearing these.
- I got mine hear,
- Minimalist shoes.
- Right.
- They've got an extra wide toe box.
- Look how wide it has.
- Yep, there you go.
And that can be worn, they're a nice thing if you have
this problem coming over and over again.
- [Bob] Right.
- Get a shoe you don't have to have the minimalist
but make sure you get the extra--
- Wide based.
- Wide, wide toe box we call that.
Next thing again avoid walking,
particularly on uneven terrain
where it really stresses your toe.
- Yeah, for the short term.
- Right, exactly. - Not forever.
- And just to use a cane may be helpful or a crutch.
- For a while again, short term.
- If that's my sore foot,
I'm gonna use it in the opposite hand
and you'll know because it's gonna reduce the pain
by a fair amount, at least 50%.
And when it gets better, put the cane back in the closet.
Now, let's get into chronic pain.
Let's say your big toe has been hurting.
And it's kind of gradually getting worse
over the last few weeks or months.
And you kind of ignored it for a number of--
- Right.
- And now it's getting--
- Hoping it's gonna go away.
- Yep, and it doesn't all of a sudden you start limping
and sometimes people start limping without knowing about it
because it's so gradual.
And then someone says why are you limping?
And it's, oh.
- I did not know I was.
- It must be because my toes are getting worse.
- Right.
- So number one thing is check out your footwear again.
Make sure you've got the wide enough toe box.
And you're addressing that, no high heels for sure.
- Right.
- Those--
- They'll squish your foot down into a narrow base.
- I don't think they make a high heel
with a wide toe box.(laughs)
- Right, maybe you're wrong.
- Okay, so the next thing you wanna do, it's probably
a good chance is arthritic changes in that big toe joint.
So we need to get that joint ranged out
or get the flexibility back where it needs to be.
So I'm gonna show you what I like to do.
And I had to - Gotcha.
- I was instructed just initially a number of years ago
in a continuing ed course and it was called
When The Foot Hits The Ground--
- Everything Changes.
- Yeah, there you go Bob, did you take that course?
- No, but I remember it.
- But anyways, we're addressing the big toe.
Let's look at this.
Here I got my nice skeleton toe socks on.
- Right.
- Are we on this?
So we've got...
- The joints.
- Yep, the joints.
So the bone way out at the end
and then we've got a middle one and then here is the joint
that usually gets the most problems.
- Right.
- Okay, so to get that joint mobilized I'm gonna suggest
starting with a gross stretch range of motion.
- Right.
- And we're just gonna go down as far as you can
and then go up, but not too aggressively to start out with.
Do a few reps of that down.
- Is it warmed up?
- Yep.
And you notice I have my toe
or my foot on a surface that's firm.
So I have a distinct point of flexion there.
And I'm gonna stabilize here to go up.
So we're working those joints
and we're not just moving the whole foot up and down.
- Right.
- That's the big concern there, okay?
All right 10 reps is probably pretty good.
And then you can grab the toe this is rather interesting.
See if you can stabilize this, you can do this.
- I was gonna say--
- Seated like this as well, but just for viewing sakes
I'm gonna do it like this.
I'm gonna stabilize this joint here, push it.
I'm gonna grab that toe and do some rotation.
- All right.
- Yeah, a lot of people won't think about that.
You know, like Mulligan the famous therapist.
- Right, exactly.
- He talked about this
and you may go out here and rotate it again.
I always think of this as like, you know
you got some rust in those joints,
you're trying to break the rust up
and get things moving again.
- Just joint moving.
- Yep, then the next one
and particularly if this is a bunion problem.
- Right.
- And your toes are being squished in all the time,
we want to move that toe out and get that space in there
and you can go in, but usually this way is fine.
It's typically out and back and forth and work that
and you can do some rotation with that outward motion.
- Right.
- Okay.
- Whatever feels good.
- Absolutely.
- Right.
- Okay, good.
Now, the next phase is to get into that joint.
And now this is not range of motion.
This is mobilization.
- Mobilization, right?
- So I am going to really stabilize.
Let's look at this.
This bone right here I'm gonna grab that.
I'm gonna get a hold of this bone
and I'm going to really focus on that joint
and I'm gonna do it just like so
- Going up and down. - Yep.
So I'm gonna grab here, grab here
and I'm gonna do some vertical mold.
So my hand here is going up this way.
- Gotcha.
- All right, stabilizing here and I'm gonna go up.
Now you can see if you really zoom in
there is some motion there, but it's not a lot
and you won't get a lot and it's--
- I can see it.
- Yep, it's there and if I push down again, not a lot
but there's some motion there.
- And if the toe pops up, just plug it back in.
- (laughs) Yeah, make sure you keep it.
The other thing that oftentimes is missed
is you grab this bone here
and the bone here for the next toe
and I'm gonna go up and down like this.
- Right, like a teeter-totter.
- Yep, and all these stretches you can go
through the whole foot and it's not a bad idea.
I'm focusing on the big toe,
'cause that's what we're talking about.
Work that, and then I'm gonna go grab the next joint.
Here I'm gonna grab there with two fingers
and then I'm going to stretch that, flex that down and up.
And I'm gonna go up and down,
do a little rotation with that back and forth.
So I'm just really isolating
when we do mobilization versus--
- Yep, really trying to get into the different joints.
- Yeah, you know, even if you don't have a toe problem,
you'd do this.
- Right, it feels good.
- Yeah, when I went to that course the teacher,
I don't know what she was doing.
I do know, but she grabbed my foot
and she's pushing down pretty aggressively.
And I thought, oh, that hurts.
And I was trying to be tough.
"It kind of hurts", I said.
She's like going on.
Thank God.
But like a minute later it just felt so good.
'Cause my toe had never been stretched like that.
- Felt so good.
- It did afterwards and that's the idea with these,
stretch 'em to the point where there's some pain,
but after you get done, it should feel better.
If it doesn't and it hurts, doesn't mean you quit doing it.
You give it a rest for a day or so, and then come back
- [Bob] Try it again.
- And don't do so aggressively.
- Right.
- Yeah, my toe is feeling better already Bob.
All right, let's address the old bunions.
- Right.
- And bunions, we talked about stretching a little bit
but we're gonna show you an easy way to stretch it
that you can do without actually stretching.
- They would definitely cause greater toe pain,
I mean bunions. - Yep
- And if your foot is getting squished together
you're wanna stretch it out.
- Right, particularly that big toe.
- So we're using some yoga toes here
and I just put 'em in place quite stylish.
- So we've got gaping and you can see the gap is bigger
for the great toe, or the big toe
but we also gap the rest of the toes.
Because I wanna stretch all that out.
And so how long will you leave those on Bob?
- Well, at start maybe only like five minutes.
- Sure.
- You know, walk around with them see what you can do.
But eventually you could you know,
walk around for an hour with 'em on
- Yep, and leave it stretch out, but not all day long.
- Right.
- Yep, now if you don't have those
and you don't wanna buy 'em
you can make something at home.
I just took a pencil, you can use some gauze,
anything that's clean.
This is Coban,
which is actually used for a number of things,
but they make medical grade and I wrapped it around
just to get a diameter that I need.
And I'm gonna cut this off.
And what you do is you just put that between your toe
like that and look at the gap it's made.
- Right.
- I've got a stretch going on there.
Obviously I wouldn't leave this pencil like this.
You're gonna use something short that would be cut off or--
- Sure.
- Or whatever.
But you get the idea, you can use something
that's gonna fit in there and then you could just watch TV
or you know, hang out for a while.
- So apparently there are little rolls
you can put in your toes to do your toenails.
- Yeah, well absolutely, absolutely.
Be creative, you don't have to buy anything,
but that would work too.
'Cause some people...
You still do your toenails on?
- Yeah, all the time.
- See what I'm talking about.
All right well very good.
I hope these exercises and these tips with the shoes
and stuff help you with your toe pain.
Get you walking normal again, feeling good.
And maybe you can go out dancing,
perhaps little ballroom dancing Bob.
- There we go.
- Enjoy the day.