My Hip Hurts… But Has Anyone Questioned the Big Toe?
- jacquihoitingh
- Aug 10
- 3 min read
When a client has hip pain, everyone looks at the hip.
That’s understandable. It’s where the pain is.
But before deciding that the hip is the problem, it may be worth looking at what is happening at the opposite end of the leg—particularly during the final part of each step.
Because the big toe isn’t merely along for the ride.
It has an important role in stability, balance and moving the body forward.
The big toe helps turn the foot into a lever
The foot needs to perform two seemingly contradictory jobs.
When it meets the ground, it needs to be adaptable enough to absorb force and respond to the surface beneath it.
But when we move forward, it needs to become firm enough to propel us into the next step.
The big toe helps make that transition possible.
As the body moves over the planted foot, the big toe bends upwards. This tensions the plantar fascia, raises the arch and helps transform the foot from a flexible shock absorber into a more stable lever.
This is known as the windlass mechanism.
Without that transition, pushing forward becomes less efficient—and the body may need to find another route.
What happens when the big toe isn’t available?
A big toe may be stiff, painful, weak or simply reluctant to accept load.
There may be arthritis, a bunion, a previous injury, unsuitable footwear or a long-established movement pattern.
Whatever the reason, the person still needs to move forward.
The body may respond by:
Turning the foot out
Rolling across the smaller toes
Shifting weight towards the outside of the foot
Lifting the heel earlier
Shortening the step
Spending less time on that leg
Asking the ankle, knee or hip to provide more movement or force
These aren’t necessarily faults.
They are solutions.
The body is finding a way to continue walking despite one part of the system being less available.
So how could that affect the hip?
Walking is not a collection of separate joint movements.
The foot, ankle, knee, hip and pelvis are continually sharing movement and force.
If someone avoids moving over and pushing through their big toe, the timing and direction of their step can change. Their stride may shorten, the leg may rotate differently and the hip may have to alter the way it controls or propels the body.
Experimental studies in which movement of the big-toe joint was restricted found changes in walking speed, stride length and the mechanics or loading of the ankle, knee and hip.
That doesn’t prove that a restricted big toe causes every painful hip.
It does, however, give us a strong reason to include it in our investigation.
The big toe also contributes to balance
The big toe provides an important point of contact with the ground.
It helps us sense where our weight is moving and contributes to balance during standing, walking and single-leg movement.
If the nervous system doesn’t feel confident loading through that point, it may organise the rest of the body differently to maintain stability.
Once again, the visible adaptation may appear much higher up than the original problem.
Don’t only assess it on the treatment table
A toe may appear to have adequate movement when tested passively but behave very differently when it is carrying body weight.
That is why observation matters.
Watch your client walk and ask:
Does the heel lift unusually early?
Does the foot turn out?
Do they roll through the big toe or escape across the smaller toes?
Is one step shorter than the other?
Do they spend less time on one leg?
Can the big toe bend while the foot is loaded?
Is the movement comfortable and similar on both sides?
The question isn’t simply, “Can this toe move?”
It’s:
“Does the body trust this toe enough to use it?”
Question the big toe - don’t automatically blame it
The big toe may not be the cause of the hip pain.
Its restriction may itself be another adaptation to something happening elsewhere.
That’s why the answer isn’t to mobilise every big toe belonging to someone with a painful hip.
The value lies in noticing the relationship.
If the body is avoiding the big toe, ask why.
If it has changed the person’s stride, ask who is compensating.
And if the hip is repeatedly being treated without lasting improvement, perhaps it’s time to look beyond where it hurts.
The body will always find a way forward.
Our job is to notice who is paying for it.
If you enjoy exploring the body’s less-obvious adaptations, download my free guide here:
The Listening Body- The best therapists don’t just know more techniques. They ask better questions-and recognise the clues the body is quietly offering.
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