Last time we focused on feet. Today, we zoom in on toes. (Just to warn you –I’m going to go slightly scientific here for the next four paragraphs — after that we’ll get back to normal).
“Toes will always be at the end of your feet, but at the start of your journey.”
― Anthony T. Hincks
A typical foot features five toes, numbered I to V, as shown in Figure 1.
Your toes contain fourteen bones or phalanges — two in the big toe, three in each of the others. Phalanges are labelled by their distance from the body. The closest to you is the proximal phalange. Next comes the medial phalange, then the distal phalange. (“Distal” sounds like “distant”, “medial” like “middle”, and “proximal” suggests “proximity”). At the base of each toe is the metatarsophalangeal (MTP) joint. You can see these in Figures 2 and 3, below.
Many different muscles act on your toes. I’ve listed some, and I’ll be posting a page detailing their location and function, available to subscribers only. (Don’t worry if you haven’t yet got your subscription — you can easily join us for free. Details are on the Home page, and we’d love to have you with us).
Dancers’ toes get quite busy. We’ve mentioned how essential the big toe is to walking and jumping — it pushes powerfully downwards as the flexor hallucis longus muscle contracts, pulling a tendon under your foot, and drawing your distal phalange towards the ground. This action also stops you falling forwards on demi-pointe. Your big toe’s proximal phalange is powered by flexor hallucis brevis. You point the other toes with flexor digitorum muscles (longus and brevis) – there’s even one (flexor digitorum minimi brevis) just for the little toe. They are helped by various interossei, lumbricals and a quadratus plantae. This is plantar flexion, which dancers call “stretching” or “pointing” (as in battement tendu).
Your toes can also tilt upwards (dorsiflexion), which dancers call “flexing” . The big toe is dorsiflexed by the extensor hallucis longus. Toes II to V are lifted by the extensor digitorum longus, and by the extensor digitorum brevis. Your toes can separate, using abductor muscles (specifically abductor hallucis and abductor digiti minimi). They can also squeeze together (adduction), thanks to the adductor hallucis, which pulls the big toe inwards.
Right, that’s it for the science. Back to reality.
“You have dancing shoes with nimble soles. I have a soul of lead“.
— William Shakespeare, Romeo and Juliet
Not all sets of toes are identical – different people have different foot-types. Some peoples’ second toe appears to be longer than their first (the so-called Morton’s Toe, commemorating the physician who first described it). This is the “Greek” foot shown in Figure 4 below, and often seen in classical Greek statuary. It can cause problems for dancers, including “rolling”, pain under the foot and metatarsal fractures, and can affect ankles, knees, gait and posture. There are various conservative or surgical treatment methods.
Then there’s the “Egyptian” foot (Figure 5), where the big toe is the longest, with toes II to V shortening progressively along an imaginary line angled around 45°, and the “Roman” foot (Figure 6), with first, second and third toes all about the same length; this foot is usually short and wide.
Toes suffer various afflictions, often traceable to incorrect footwear. Tight or pointed shoes might cause hallux valgus, angling the big toe inwards towards its neighbour and levering the first MTP joint outwards, with inflammation, painful bunions, swelling and restricted movement. This displacement of the first metatarsal bone stresses the medial longitudinal arch, “flattening” the foot and impacting the biomechanics of the entire leg. Arthritis may even completely immobilise the big toe (hallux rigidus).
Shoe design can be risky, particularly the raised heel and turned-up toes of some athletic footgear. These overload the second MTP joint, producing pain, joint capsule inflammation and stiffness. Conservative treatments include toe-spacers, physiotherapy and corrective orthotic insoles or splints.
Tight shoes may also cause Hammer Toe. Here the MTP dorsiflexes while the proximal joint folds downwards, making a hammer shape and possibly damaging the Plantar Plate ligament under the toe. There’s also Claw Toe, where the MTP dorsiflexes while the other joints plantar flex, or Mallet Toe, when the distal joint plantar flexes. They can sometimes be corrected through physiotherapy, taping, and rest.
“A brand-new pair of toe shoes presents itself to us as an enemy with a will of its own that must be tamed.” — Toni Bentley
As dancers know, pointe work is hard on toes (nails in particular). Nails need care – if they get damaged, you’re not going to be happy until they recover. Traditionally, people protect them with lambswool, pouches, J-cloths, gel pads, paper tissues, or by bandaging each individual toe. Keep toenails short — cut them straight across, ideally after a shower, when they’re soft. With bruised nails, even the weight of bedclothes can keep you awake. Wear loose-fitting thick socks and stick your feet out from under the covers – maybe then you can drift off. Any yellow-brown or white spot under the toenail could be nail fungus (onchomycosis) – over time it can destroy the nail, so get it treated.
Years ago, I was stupid enough to try an assemblé in sandals, ripping the nail off my big toe. The pain (and the mess…) were impressive — I couldn’t dance for weeks. Don’t do stuff like that, look after them.
“Bleeding feet will bond us.” — Liza Minelli
Poorly-fitted pointe shoes (or not wearing socks or tights inside them) invite corns and blisters. Plasters might help, but serious corns need a podiatrist. If you have clear blisters, lance them carefully using a sterile needle — drain and bandage – leave as much skin as possible in place. (Blisters filled with blood should be left alone, under a sterile dressing – they will heal eventually. You can ease pressure by sticking a little circular pad around them.) There are various folk-remedies involving eggs, raw meat or other groceries, but infections or serious wounds require proper medical treatment.
Keep the skin of your toes moisturised and supple so they don’t dry out and crack. Callouses can be reduced (carefully) with a pumice stone or file. Don’t remove them – they’re not pretty, but they protect your feet. Ballet shoes, especially pointes, should be kept dry, not left in your bag overnight — they go soft and smelly, and nasty things grow there. Dry them on the radiator (on a towel, so they don’t scorch – check them occasionally). If possible, alternate two or three pairs, so they can dry out properly when not in use.
“Please send me your last pair of shoes, worn out with dancing as you mentioned in your letter, so that I might have something to press against my heart.” — Johann Wolfgang von Goethe
Next time, on our way up towards the ankle, we’ll explore foot anatomy, and discuss how to use, protect and treat these fantastic feet. They deserve your care, love and respect – the poor little things are constantly on duty, and they’re with us, faithfully, every step of the way.
“Dancing is the poetry of the foot“.
— John Dryden
© Jeremy Leslie-Spinks
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References
Calais-Germain, B. (2007). Anatomy of Movement (Revised Ed.) Seattle, WA: Eastland Press, Inc. Purdy, J. (2018). https://www.jackrabbitdance.com/blog/foot-care-dancers/
Wikipedia (2019) https://en.wikipedia.org/wiki/Hammer_toe
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