[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) › Big toe [Skeletal system](https://durgical.com/en/anatomy/system/skeletal-system/) · [Lower limb](https://durgical.com/en/anatomy/region/lower-limb/) # Big toe The big toe has two small bones (phalanges); it does most of the pushing off when walking. Official name: Great toe [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=lower_limb&select=toe_1&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The big toe (hallux), made of two small bones called phalanges. ## What it does Takes most of the push-off force when you walk and run, and helps with balance. ## Key points - The [skin](https://durgical.com/en/anatomy/skin/) over the dorsum of the big toe is the classic L5 dermatome, and extensor hallucis longus strength the classic L5 motor test - Acute gout classically starts at the first metatarsophalangeal (MTP) joint (podagra) - Turf toe is graded I–III, from a stretched plantar plate to a complete tear with sesamoid displacement ## Key facts **Joints with** First metatarsal (MTP joint, with sesamoids); one interphalangeal joint **Landmarks** Two phalanges; flexor and extensor hallucis longus to distal phalanx; abductor, adductor and flexor hallucis brevis to proximal phalanx ## Relations **Behind** [First metatarsal](https://durgical.com/en/anatomy/first/) head and the two [sesamoids](https://durgical.com/en/anatomy/sesamoid-bones-of-foot/) at the MTP joint **Above** [Extensor hallucis longus](https://durgical.com/en/anatomy/extensor-hallucis-longus/) to the distal phalanx; [extensor hallucis brevis](https://durgical.com/en/anatomy/extensor-hallucis-brevis/) to the proximal phalanx **Below** [Flexor hallucis longus](https://durgical.com/en/anatomy/flexor-hallucis-longus/) to the distal phalanx, running between the sesamoids; plantar plate; [flexor hallucis brevis](https://durgical.com/en/anatomy/flexor-hallucis-brevis/) through the sesamoids **Medial** [Abductor hallucis](https://durgical.com/en/anatomy/abductor-hallucis/) to the base of the proximal phalanx; the dorsomedial cutaneous nerve and the medial plantar digital nerve of the big toe **Lateral** [Adductor hallucis](https://durgical.com/en/anatomy/adductor-hallucis/) through the lateral sesamoid; the first web space, supplied by the [deep fibular nerve](https://durgical.com/en/anatomy/deep-fibular-nerve/) ## How to find it The MTP joint line is felt on the dorsomedial side while the toe is moved up and down; the single interphalangeal joint lies under the toe's crease. A large range of passive dorsiflexion at the MTP joint is normal and is needed for push-off. ## Examination - Grind test: axial compression with rotation of the first MTP joint is painful in hallux rigidus and arthritis - Jack test: passive dorsiflexion of the big toe should raise the medial arch through the [plantar fascia](https://durgical.com/en/anatomy/plantar-aponeurosis/); failure suggests a rigid flatfoot ## On imaging Standing AP view for hallux valgus and interphalangeal angles; lateral view for the dorsal spurs of hallux rigidus. In chronic gout, punched-out erosions with overhanging edges appear near the first MTP joint. ## Common problems - Bunion (hallux valgus): the big toe leans toward the [second toe](https://durgical.com/en/anatomy/second-toe/). - Turf toe: a sprain of the big toe joint when it is bent up too far, common on artificial turf. - Stiffness from arthritis (hallux rigidus), ingrown toenails and fractures. ## How it is diagnosed A physical exam; X-rays taken standing; MRI for turf toe. ## Treatment - Proper shoes, taping, stiff inserts and rest. - Physical therapy for turf toe, with a gradual return to sport. - Surgery for severe bunions, arthritis or torn ligaments under the joint. ## Clinical notes - Hallux valgus interphalangeus: the lateral deviation lies at the interphalangeal joint rather than the MTP joint - The big toe can be transferred to the hand to rebuild a lost thumb (toe-to-thumb transfer) ## Anatomical variants - A small sesamoid under the interphalangeal joint of the big toe is a frequent normal finding and should not be mistaken for a fracture fragment - The medial (tibial) sesamoid under the first metatarsal head is often in two pieces (bipartite), frequently in both feet; its smooth, rounded edges set it apart from a fracture ## Development Each phalanx has a primary centre in the shaft and a secondary centre at its base; a split or cone-shaped epiphysis can mimic a fracture. ## Related conditions - [Diabetic foot](https://durgical.com/en/conditions/diabetic-foot/) - [Hallux valgus (bunion)](https://durgical.com/en/conditions/hallux-valgus/) - [Gout](https://durgical.com/en/conditions/gout/) - [Dermatophytosis (tinea) and onychomycosis](https://durgical.com/en/conditions/dermatophytosis-and-onychomycosis/) - [Cutaneous larva migrans](https://durgical.com/en/conditions/cutaneous-larva-migrans/) - [Tungiasis and furuncular myiasis](https://durgical.com/en/conditions/tungiasis-and-furuncular-myiasis/) ## Test yourself Think of the answer, then tap the question to see it. ## Which dermatome and which motor test are classically linked to the big toe? L5: the skin over the dorsum of the big toe, and extensor hallucis longus strength. ## Which joint is classically affected first in acute gout? The first metatarsophalangeal joint of the big toe (podagra). ## How is turf toe graded? I–III: from a stretched plantar plate to a complete tear with sesamoid displacement. [Add to my cards (3)](https://durgical.app/estudiar/?add=/en/anatomy/great-toe/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** hallux; phalanges pedis TA2 171 **Official Spanish (DeCS)** Hallux (primer dedo del pie) DeCS D014034 **English (TA2)** Great toe **Also called** first toe · first digit of foot · digit 1 of foot · phalangeal bones of foot ## Related - [First metatarsal](https://durgical.com/en/anatomy/first/) - [Sesamoids](https://durgical.com/en/anatomy/sesamoid-bones-of-foot/) - [Toe arteries](https://durgical.com/en/anatomy/dorsal-digital-arteries-of-foot/) - [Abductor hallucis](https://durgical.com/en/anatomy/abductor-hallucis/) - [Extensor hallucis brevis](https://durgical.com/en/anatomy/extensor-hallucis-brevis/) - [Flexor hallucis brevis](https://durgical.com/en/anatomy/flexor-hallucis-brevis/) - [Big toe flexor tendon](https://durgical.com/en/anatomy/tendon-of-flexor-hallucis-longus/) - [MTP ligaments and plantar plate](https://durgical.com/en/anatomy/collateral-metatarsophalangeal-ligaments/) Sources: Terminologia Anatomica (TA2); [DeCS](https://decs.bvsalud.org/es/ths/resource/?id=23483); [Anatomy, Bony Pelvis and Lower Limb: Foot and Ankle](https://www.ncbi.nlm.nih.gov/books/NBK546698/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/great-toe/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/great-toe/