ESCANABA — Walking can be a traumatic act. This may seem a ridiculous statement but when examined from a perspective of an individual’s biomechanics, it is accurate. Although we don’t particularly think about it, walking is extremely complex. With every single step, various joints are moving, muscles pulling, ligaments tightening. Often, with less than optimal anatomy, these structures won’t function correctly, and gait is disturbed, altered, or changed in some fashion.

Also important in this discussion is the intricate interrelationship between the many body parts involved in standing and walking. As an example, the structures supporting the knee will affect how well the joint is aligned, determining how it works and what kind of problems develop. An alteration in efficient, appropriate human ambulation will eventually lead to stress to some structure or other. Depending on how all these parts are arranged, and therefore how they are working, symptoms will occur sooner or later somewhere.

The repetitive nature of gait means any small abnormality in function will be magnified over time. With the average citizen taking five to ten thousand steps a day, day after day, year after year, it should be understandable why so many problems of the musculoskeletal system are not the result of an injury or accident but improper, unhealthy gait mechanics.

Evidence of this relationship can be seen in the fact that most who have a knee replacement are told it’s simply due to “arthritis,” which is hardly a definitive diagnosis. Osteoarthritis is a specific condition but many undergoing orthopedic surgeries are not told they have this common disease. Too often, when a healthcare provider is not certain why a body part has worn out, it’s often easier to simply say it’s “arthritis.” Regular use of any joint with poor alignment will cause subtle, repetitive microtrauma. Limitations will eventually ensue as parts wear out, cartilage thins, tendons become diseased.

A joint commonly subject to these degenerative changes is one that is necessary for normal, proper gait. It is the big toe joint at the base of the big toe in the ball of the foot (the metatarsal-phalangeal joint). This is a unique articulation, functioning with a special axis of motion, distinct from that of any other in the body.

Sufficient motion up (listed in the textbooks as sixty degrees), is necessary to walk. When the components involved with this part don’t allow for sufficient motion, gait is affected. Ambulation becomes less propulsive, less powerful, over time. This will also serve to slow one’s walking speed. This limitation also results in the aforementioned stress to the knee joint, hips, and spine.

When the first metatarsal is excessively elevated, the big toe can’t glide over it, thus preventing normal motion. But many things can lead to this stiffness. If the first metatarsal bone is too long, jamming occurs and predictably degeneration. If someone’s arch collapses sufficiently, the metatarsal bone won’t be in an effective position for walking and the joint will jam repeatedly.

Surprisingly, many Americans are suffering from limited motion of this joint have no idea of the situation. Pain is experienced from this body part a minority of the time. But, as mentioned, other areas will be abnormally stressed. The body will automatically compensate for the limited motion of the big toe, but this compensation will usually impair the health of some other part, be it cartilage, tendon, ligament, even bone.

Signs that the big toe joint is moving improperly may include stiffness (which is often not painful), slowed walking speed, even a gradual enlargement of the joint as the metatarsal and toe bones react to the stress by overgrowing. This may lead to the joint getting diffusely enlarged or sometimes specific, visible spurs will form. Commonly, the joint in the middle of toe will be pushed upward and out of position. Consequently, when standing, it won’t even touch the ground.

Out for a casual stroll, few of us consider the health of our big toe joints. But the motion allowed by this joint is a requirement for normal gait. Should damage occur to it, regardless of the cause, the result will typically be a limitation of the amount of motion up of the big toe joint. Gait will be affected although the manifestations of these changes vary greatly since we all are at least a little different (and sometimes a lot!). This is certainly the case when it comes to gait and how someone walks.

We don’t have this process of walking sufficiently quantified to make definitive predictions about who will have problems in the future. Who will experience the limitation in ability to walk or who will suffer degeneration of the knee. Which person with a stiffening big toe joint will have a slipped disc?

Few physicians have the background to make definitive associations between what’s happening with the foot and these other structures which are supported by the feet. But make no mistake, the relationship is real. It is a part of every step of every day, taken over the course of your life.

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Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with offices in Escanaba, Marquette, and L’Anse. McLean has lectured internationally on wound care and surgery, being board certified in surgery, orthotic therapy and wound care. His articles on health and wellness appear in multiple local and national publications. Dr. McLean welcomes subject requests for future articles at drcmclean@outlook.com.