Toe Function and Mobility: Expert Insights from Dr. Miguel Cunha of Gotham Footcare Gotham Footcare

Our toes, despite their size, play a crucial role in our overall body function and athletic performance. Dr. Miguel Cunha, the founder of Gotham Footcare and a board-certified podiatrist, specializes in treating foot and ankle issues and emphasizes the importance of toe health. During a recent interview, Dr. Cunha shared his insights on the anatomy of toes, common issues athletes face, and effective prehab and rehab exercises. Here, we’ll delve into his responses, explore how to maintain toe function and mobility, and answer the most common questions regarding toe care.

The Anatomy of the Toes and Their Role in Athletic Performance

“The toes consist of multiple osseous and soft tissues, including tendons, nerves, and ligaments that support our body weight,” Dr. Cunha explains. Each toe contains small bones called phalanges that connect to metatarsals, the longer bones in the midfoot. Most toes are made up of three phalanx bones—the proximal, middle, and distal—except for the big toe, which has only two.

“The primary function of your toes is to provide posture, balance, and propulsion during the gait cycle,” he notes. When walking or running, the toes help thrust your body forward, allowing for increased stride length and faster speeds. Their role in maintaining stability and balance is essential not only in everyday movements but also in athletic performance.

Common Toe Issues in Athletes

Athletes are especially prone to toe-related issues due to the constant stress and strain placed on their feet. Dr. Cunha highlights three of the most common issues he sees in athletes: hammertoe deformities, corns and calluses, and runner’s nails.

• Hammertoes: “Hammertoes are caused by a muscular imbalance in the foot where the tendons on the bottom overpower those on the top,” Dr. Cunha explains. As the toes contract, they can become permanently bent, causing discomfort and pain when wearing shoes. The friction between the bent toe and footwear often leads to the development of painful corns.
• Corns and Calluses: “As we age, the fat pad underneath our feet becomes thinner, leading to fat pad atrophy,” Dr. Cunha notes. This can cause calluses to form, as the skin is caught between the bones of the foot and the hard surfaces we walk on. Corns, a type of callus, are particularly painful and occur on the tops or sides of toes due to hammertoes or ill-fitting shoes.
• Runner’s Nails: Another common issue among athletes is runner’s nails. “One of the biggest mistakes my patients make before a marathon is not trimming their toenails short enough,” says Dr. Cunha. Black toenails, caused by repetitive trauma during running, can lead to bruising, blistering, and even the loss of the toenail. This condition, known as a subungual hematoma, is not only painful but can affect athletic performance.

Prehab and Rehab Exercises for Toe Mobility

Keeping toes flexible and mobile is key to preventing the issues discussed above. Dr. Cunha recommends the following exercises to improve toe function:

1. Toe Curls
   Sit barefoot and place a towel or a few marbles on the floor. Place the upper half of your foot on the towel or marbles, keeping your heel on the ground. Crunch the towel or marbles up with your toes, then relax. “This exercise strengthens the muscles in your toes and improves their flexibility,” Dr. Cunha explains. Repeat 10 to 12 times.
2. Toe Taps
   From the same seated position, extend your big toe downward while lifting your lesser toes in the air. Lightly tap the floor with your big toe while keeping your other toes elevated. Reverse the position, tapping with your lesser toes while lifting your big toe. “This helps improve coordination and mobility in the toes,” says Dr. Cunha. Repeat 10 to 12 times on each side.
3. Toe Stretches
   Sit with your legs extended straight out in front of you. Wrap a towel around your toes and gently pull the ends toward you, stretching the toes and foot. Hold the stretch for 20 to 30 seconds. “Toe stretches help elongate the muscles, improving range of motion,” Dr. Cunha adds.
4. Toe Rolls
   Stand barefoot on a flat surface. Lift all your toes together, then roll them down one at a time, from one side to the other. “This exercise mimics finger rolls, improving dexterity and control,” Dr. Cunha says. Repeat 10 to 12 times.
5. Toe Squeezes
   Sitting with one foot over the opposite thigh, slide your fingers between your toes and squeeze them together, pinching your fingers. Release and repeat. “This simple exercise strengthens the muscles and ligaments in the toes,” says Dr. Cunha.

Treatment Interventions for Toe Issues

In addition to exercises, other interventions can help treat toe deformities, particularly hammertoes. Dr. Cunha recommends evaluating your footwear to ensure it provides adequate space for your toes. “Avoid shoes with narrow toe boxes, as they can aggravate conditions like hammertoes,” he advises. Shoes should be about half an inch longer than your longest toe to accommodate swelling and movement during walking or running.

Dr. Cunha also suggests tracing your foot at the end of the day and placing your shoe over the tracing. “If your foot extends beyond the outline of the shoe, the shoe is too narrow,” he warns. He recommends shopping for shoes later in the day when your feet are most swollen to ensure a comfortable fit.

For mild cases of hammertoes, using products like hammertoe pads, toe spacers, or toe socks can alleviate discomfort. Dr. Cunha also recommends custom orthotics for added support and cushioning. In severe cases, surgery may be necessary to correct the deformity.

Toe-Directed Tools for Athletes

Several toe-directed tools can help athletes maintain mobility and prevent injury:

• Toe Spacers: “Toe spacers help align the toes properly, preventing overcrowding and reducing friction,” Dr. Cunha explains. This is particularly useful for athletes prone to hammertoes or bunions.
• Hammer Toe Pads: These provide cushioning for the tops of the toes, protecting against pressure and reducing pain from shoes rubbing against bent toes.
• Toe Socks: Dr. Cunha notes that toe socks can keep toes separated, reducing the risk of friction and calluses during activities like running or hiking.
• Athletic Shoes with Wide Toe Boxes: For athletes, wearing shoes with a wide toe box ensures that toes have enough room to move freely, preventing deformities like hammertoes.

Most Asked Questions About Toe Function and Foot Health

Do I need custom orthotics for hammertoes?
Custom orthotics can help alleviate pain and prevent the progression of hammertoes. By providing added support and cushioning, orthotics improve foot alignment and reduce pressure on the toes. Learn more about custom orthotics here.

What are the best shoes for preventing toe deformities?
Athletic shoes with a wide toe box provide ample room for your toes to move freely. Dr. Cunha emphasizes the importance of avoiding narrow shoes that compress the toes, leading to issues like hammertoes or bunions.

How can I treat corns and calluses?
Corns and calluses develop from friction and pressure on the skin. Dr. Cunha recommends using pumice stones to gently remove calluses and wearing cushioned pads to protect against further irritation. More foot care tips here.

For more information on foot health or to book an appointment with Dr. Cunha, visit Gotham Footcare.