Ode to the Big Toe

It takes more nail polish than any of the others and is a target for gout, ingrown nails and some fairly disgusting fungi.

And it is ignored. Oh, how it is ignored.

Be honest: How often do you pay any heed (much less homage) to the big toe--the digit that helps propel you to work and play?

“It’s the pushy guy of the group,” says Dr. Don Hovancsek, chairman of the public affairs committee for the American Podiatric Medical Assn. Sure, the littler piggies help with balance and propulsion, but it’s the big tootsie--the hallux, in foot doc lingo--that plays a starring role.

Hallux-ology

The big toe is anatomically unique among its brethren. While other toes have three bones each, the big toe has two. Those bones, like the ones in the fingers, are called phalanges by the orthopedic surgeons and podiatrists whose mission in life is to keep our feet happy.

And while the big toe comes by its name honestly, it’s not always the longest.

Often, the second toe is a bit longer than the big toe, says Dr. William G. Hamilton, a New York orthopedic surgeon and former president of the Foot and Ankle Society, part of the American Academy of Orthopaedic Surgeons. It’s a foot type that’s especially common in Americans.

Others have what Hamilton dubs the Egyptian foot--in which the big toe is the longest.

The Follicle Factor

Hair is another big big-toe variable: Some people’s are hairless, others proudly sprout long black whisker-like growths.

What does it all mean?

“Hair below the ankle is usually a sign of good circulation,” says Hamilton, who hastens to add: “If you don’t have hair, it’s not always a sign of poor circulation.”

Big Toes Gone Bad

The big toe is vulnerable to a host of problems:

* Ingrown nails, which can become infected, are most common in the big toe, perhaps because of its location, Hovancsek says. Most ingrown toenails are hereditary, he says, but they can be aggravated by ill-fitting shoes. Ingrown toenails can be especially dangerous in people with diabetes, warns Dr. Michael Levi, a Santa Monica podiatrist on staff at St. John’s Hospital and Health Center, because infection can progress more rapidly.

Treatment: A foot specialist might trim it back or put acid on it to kill the nail root to prevent recurrence.

* Gout, a metabolic disorder that causes attacks of arthritis, most often strikes the big toe joint.

Treatment: Prescription anti-inflammatories relieve the pain.

The big toe is not the most commonly fractured toe--the little toe usually gets that award--but it claims its share of breaks, foot specialists say. (Soccer players often fracture the big toe.) Broken toes should not be taken lightly. They’re often an easy call since they’re very swollen and painful, but anyone unsure should seek a professional opinion.

Treatment could involve surgery. Figure four to six weeks before your hallux is back in the swing--and up to a year before your toenail, if crushed in the mishap, grows a healthy replacement.

* Fungal infections affecting the nails--perhaps the ugliest big toe malady--can be tough to shake. The big toe is especially susceptible because it’s prone to more trauma and thus is more vulnerable to infection. But newer oral anti-fungal drugs are more effective with fewer side effects, Levi says. Still, it’s a long haul. Remember that slow nail growth? Figure a year before you’re clear.

* Bunions are painful enlargements at the joint of the big toe. The skin over the joint swells and is often tender. Poorly fitting shoes can bring them on. If bunions become disabling, surgery is recommended.

* Turf-toe, an inflammation of the big toe joint, afflicts football players and is akin to a super-stubbed toe.

* Hallux rigidus describes a big toe with osteoarthritis. “The big toe joint moves a lot,” Levi says. “Over time, there can be arthritic changes and calcium deposits.” Sometimes surgery is recommended.

Treating Toes Right

Big toes stuffed into shoes rebel, and the little ones follow.

There should be a one-half-inch space from the end of the longest toe to the end of the shoe, according to the American Academy of Orthopaedic Surgeons. Don’t buy shoes with too narrow a toe box. Avoid especially high heel shoes with a pointed narrow toe box that will crowd your toes.