What is a toe drag in hockey. How to execute a perfect toe drag on ice. Why is the toe drag considered a deke. How to improve your toe drag skills. What are the best practices for mastering this essential hockey move.
Understanding the Hockey Toe Drag: A Game-Changing Move
The toe drag is a sophisticated offensive maneuver in ice hockey that can elevate a player’s performance to new heights. This technique involves using the toe of the stick blade to pull or “drag” the puck across the body, allowing players to maintain control while evading defenders. The move requires a combination of precise puck handling, hand-eye coordination, and quick thinking.
Is the toe drag considered a deke? Indeed, it is. A deke in hockey refers to any move designed to fake out opponents using body movements, stickhandling, or puck control. The toe drag fits this description perfectly, as it combines deceptive stickhandling with body feints to create space and scoring opportunities.
Executing the Perfect Toe Drag: Step-by-Step Guide
To perform an effective toe drag, players need to focus on several key elements:
- Stickhandling proficiency
- Correct body positioning
- Precise execution of the move
Step 1: Mastering Stickhandling Basics
Before attempting the toe drag, players must be comfortable with fundamental stickhandling techniques. A simple yet effective drill involves moving the puck back and forth using both hands while skating at various speeds. This exercise builds the foundation for more complex moves like the toe drag.
Step 2: Proper Body Positioning
Correct body positioning is crucial for a successful toe drag. Players should:
- Angle their body slightly towards the defender they wish to evade
- Lower their center of gravity by bending the knees
- Position the puck near their front foot
- Maintain a firm but flexible grip on the stick
Step 3: Executing the Toe Drag Move
To perform the toe drag:
- Pull back with the top hand while pushing forward with the bottom hand
- Roll the blade over the puck, using the toe to guide it towards your body
- Regain control by rolling the puck back onto the flat part of the blade
- Accelerate past the opponent
Enhancing Your Toe Drag Technique: Practice Makes Perfect
How can players improve their toe drag skills? Consistent practice and focus on fundamentals are key. Here are some strategies to enhance your technique:
Proper Grip and Stick Positioning
Place your bottom hand at the midpoint of your stick for optimal control during the toe drag. This grip allows for better maneuverability and puck handling.
Refine Your Stickhandling
Engage in drills that emphasize quick movements and puck control. These exercises will improve your overall stickhandling abilities, which are crucial for executing a smooth toe drag.
Utilize Visual Cues
Observing professional players perform toe drags can provide valuable insights. Study their techniques through video analysis or seek guidance from experienced teammates or coaches to refine your timing and execution.
Effective Training Methods for Mastering the Toe Drag
To truly excel at the toe drag, players should incorporate various training methods into their practice routines:
Mirror Practice
Stand in front of a mirror and perform slow-motion toe drags without skates. This exercise helps players familiarize themselves with the correct body positioning and movement patterns.
Dryland Training
Practice off the ice using specialized balls or pucks designed for dryland training. This allows players to work on their technique even when ice time is limited.
Obstacle Course Drills
Set up cones or other obstacles to simulate defenders. This helps players practice executing the toe drag in game-like situations.
Variable Speed Training
Practice the toe drag at different speeds to develop versatility and adaptability during actual games. This will help players perform the move effectively under various conditions.
Strengthening Exercises for Improved Toe Drag Performance
A strong wrist snap is essential for a successful toe drag. Players can incorporate specific exercises to enhance their wrist and forearm strength:
- Wrist curls
- Grip strengtheners
- Resistance band exercises
These exercises target the muscles used in the toe drag motion, improving overall control and power.
Common Mistakes to Avoid When Performing the Toe Drag
While learning the toe drag, players often encounter certain pitfalls. Being aware of these common mistakes can help improve technique and execution:
Telegraphing the Move
One frequent error is telegraphing the intention to perform a toe drag. This gives defenders time to react and counter the move. To avoid this, players should work on making the motion as smooth and natural as possible, incorporating it seamlessly into their skating stride.
Overextending the Reach
Another mistake is reaching too far when dragging the puck. This can lead to loss of balance and control. Players should focus on keeping the puck within their body’s frame, maintaining a strong center of gravity throughout the move.
Neglecting Footwork
The toe drag is not just about stickhandling; proper footwork is crucial. Many players forget to coordinate their feet with the puck movement, leading to ineffective execution. Practice combining smooth skating transitions with the toe drag motion for optimal results.
Incorporating the Toe Drag into Game Situations
How can players effectively use the toe drag during actual games? The key lies in recognizing the right moments and understanding its tactical advantages:
Creating Space in Tight Areas
The toe drag is particularly useful when navigating through congested areas of the ice. It allows players to quickly change direction and maintain puck possession in tight spaces, creating opportunities for passes or shots.
One-on-One Situations
When facing a defender one-on-one, the toe drag can be a powerful tool to create separation. By executing the move at the right moment, players can throw off the defender’s timing and gain an advantage.
Transitioning from Defense to Offense
The toe drag can be an effective move during the transition from defense to offense. It allows players to quickly change direction and evade forecheckers, initiating a counterattack.
Advanced Toe Drag Variations for Experienced Players
As players become more proficient with the basic toe drag, they can explore advanced variations to further enhance their skill set:
The Backhand Toe Drag
This variation involves performing the toe drag on the backhand side of the stick. It’s particularly useful when approaching defenders from the opposite direction and can catch them off guard.
The Double Toe Drag
The double toe drag involves performing two consecutive toe drags in quick succession. This move can be highly effective in wrong-footing defenders and creating additional space.
The Toe Drag Shot
Combining the toe drag with a quick shot can surprise goaltenders and create scoring opportunities. Players drag the puck across their body and immediately release a shot, using the momentum of the drag to add power and deception to the release.
Mental Aspects of Mastering the Toe Drag
Developing the toe drag isn’t just about physical practice; mental preparation plays a crucial role in successfully implementing this move during games:
Building Confidence
Confidence is key when attempting skill moves like the toe drag. Players should gradually incorporate the move into their game, starting with low-pressure situations and progressively challenging themselves.
Reading the Play
Successful execution of the toe drag often depends on reading the defender’s positioning and anticipating their movements. Players should practice analyzing game situations quickly to identify the best moments for attempting the toe drag.
Creativity and Adaptability
The toe drag is most effective when used creatively and unpredictably. Players should be encouraged to experiment with different setups and combinations, adapting the move to various game scenarios.
By focusing on these mental aspects alongside physical practice, players can develop a more comprehensive and effective approach to using the toe drag in their hockey repertoire.
Equipment Considerations for Optimal Toe Drag Performance
The right equipment can significantly impact a player’s ability to execute an effective toe drag. What factors should players consider when selecting gear for this move?
Stick Selection
The choice of hockey stick can greatly influence toe drag performance. Players should consider:
- Blade curve: A moderate to pronounced curve can provide better puck control during the drag motion.
- Stick flexibility: A stick with the right flex for the player’s strength and style can enhance the feel and control during the toe drag.
- Stick length: A properly sized stick allows for optimal reach and control when performing the toe drag.
Skate Considerations
While skates may not directly impact the toe drag motion, they play a crucial role in overall maneuverability and balance:
- Proper fit: Well-fitting skates provide better control and responsiveness, essential for quick movements like the toe drag.
- Blade profile: A properly profiled skate blade can enhance agility and edge control, complementing the toe drag motion.
Glove Selection
The right gloves can improve stick feel and control:
- Snug fit: Gloves that fit well allow for better stick manipulation during the toe drag.
- Palm material: Gloves with tacky palms can enhance grip on the stick, providing better control during quick movements.
By considering these equipment factors, players can optimize their gear setup for improved toe drag performance.
Analyzing Professional Players’ Toe Drag Techniques
Studying the techniques of professional players who excel at the toe drag can provide valuable insights for aspiring hockey players. How do the pros make this move look so effortless?
Patrick Kane’s Signature Move
Patrick Kane of the Chicago Blackhawks is renowned for his exceptional toe drag skills. His technique is characterized by:
- Quick, subtle movements that don’t telegraph the move
- Excellent body positioning to shield the puck
- Seamless integration of the toe drag with other dekes and shots
Sidney Crosby’s Power Move
Sidney Crosby of the Pittsburgh Penguins often uses the toe drag as part of his powerful offensive arsenal. His approach includes:
- Using his lower body strength to maintain balance during the drag
- Combining the toe drag with quick changes in skating direction
- Utilizing the move to create space for both shooting and passing opportunities
Connor McDavid’s Speed Technique
Edmonton Oilers’ Connor McDavid incorporates the toe drag into his high-speed play style. His technique features:
- Executing the toe drag at full skating speed
- Using the move to rapidly change directions while maintaining momentum
- Combining toe drags with his exceptional skating ability to create separation from defenders
By analyzing these professional techniques, players can gain insights into how to adapt and refine their own toe drag skills for maximum effectiveness on the ice.
Integrating the Toe Drag into Team Strategy
While the toe drag is often seen as an individual skill move, it can also be effectively incorporated into team strategies. How can coaches and players use this technique to enhance overall team performance?
Creating Offensive Opportunities
The toe drag can be used strategically to open up passing lanes and create scoring chances for teammates:
- Drawing defenders: A well-executed toe drag can attract multiple defenders, freeing up space for teammates.
- Zone entries: Using the toe drag during zone entries can disrupt defensive formations and create opportunities for the attacking team.
- Power play tactics: Incorporating the toe drag into power play setups can help break down penalty kill structures and create high-quality scoring chances.
Defensive Zone Breakouts
The toe drag can also be an effective tool for initiating breakouts from the defensive zone:
- Evading forecheckers: Defensemen can use the toe drag to evade aggressive forecheckers and maintain possession during breakouts.
- Creating passing options: By using the toe drag to change directions quickly, players can open up new passing lanes for smooth zone exits.
Neutral Zone Play
In the neutral zone, the toe drag can be a valuable asset for maintaining possession and creating transition opportunities:
- Beating the trap: Against teams employing a neutral zone trap, the toe drag can help players navigate through tight spaces and maintain momentum.
- Initiating counterattacks: Quick toe drags in the neutral zone can catch opponents off guard, leading to odd-man rush opportunities.
By integrating the toe drag into various aspects of team play, coaches can add an extra dimension to their strategic arsenal, making their team’s offense more dynamic and unpredictable.
The Future of the Toe Drag in Hockey
As hockey continues to evolve, how might the toe drag technique change or adapt? While it’s impossible to predict with certainty, we can speculate on potential developments based on current trends:
Increased Emphasis on Skill Development
With the growing focus on skill development in youth hockey programs, we may see more players mastering complex moves like the toe drag at younger ages. This could lead to even more creative and advanced variations of the technique in the future.
Integration with Analytics
As hockey analytics continue to advance, teams may develop more sophisticated methods of analyzing the effectiveness of moves like the toe drag. This could lead to more strategic deployment of the technique based on data-driven insights.
Adaptation to Defensive Strategies
As defenders become more adept at countering the toe drag, we may see the move evolve to incorporate new elements or be combined with other techniques to maintain its effectiveness.
Technological Enhancements
Advancements in training technology, such as virtual reality or AI-powered feedback systems, could revolutionize how players learn and perfect moves like the toe drag, potentially leading to new innovations in technique.
As the game of hockey continues to evolve, the toe drag will likely remain an important skill in players’ arsenals, adapting and changing along with the sport itself.
Hockey Toe Drag: What It Is & How to Toe Drag
If you’re looking to up your game on the ice and leave defenders in the dust, a skill that’ll help is the toe drag hockey move. Mastering a hockey toe drag can take your game to new heights. Keep reading to learn what a toe drag is and how to toe drag effectively and for tips on practicing and perfecting this essential move.
In this article, we’ll cover:
- What is a Toe Drag in Hockey?
- Is a Toe Drag a Deke?
- How to Toe Drag in Ice Hockey
- How Do I Get Better at Toe Drag?
- Hockey Toe Drag FAQ
What is a Toe Drag in Hockey?
The toe drag is an offensive move used to dodge defenders while maintaining control of the puck. It involves using the top hand on your stick to pull or “drag” the puck across your body with precision and finesse.
To execute a successful toe drag, you’ll need excellent puck-handling skills and hand-coordination. Specifically, you want firm control from your bottom hand while you apply pressure with the top one.
This combination allows for quick changes in direction and can leave opponents guessing where you’re heading on the ice and with the puck.
Is a Toe Drag a Deke?
Many new hockey players wonder if a toe drag can be considered a deke. To understand this, you must first know what constitutes a deke in hockey.
A deke is any move that involves faking out an opponent with body movements, stickhandling, or puck control. It’s designed to create space and opportunities for scoring or passing by confusing and evading defenders.
In short, yes, the toe drag qualifies as a type of deke since it involves both stickhandling skills and deceptive body movements to bypass opponents on the ice.
Read more about hockey dekes in our Hockey Deke Guide.
How to Toe Drag in Ice Hockey
The toe drag can help you maintain puck control, deceive defenders, and create scoring opportunities.
Fortunately, learning to execute the perfect toe drag isn’t hard when you have the right tips.
Step 1: Get Comfortable with Your Stickhandling
Before attempting a toe drag, you must be comfortable with basic stickhandling techniques. You can improve your stickhandling ability with a bit of practice. A simple, effective stickhandling drill involves moving the puck back and forth using both your top and bottom hand while controlling the puck when skating at various speeds.
Step 2: Position Your Body Correctly
To begin the toe drag, position yourself so your body is slightly angled toward the defender or opponent you want to evade. Lower your center of mass by flexing joints to give more room for maneuverability.
- Bend your knees: Keep a low center of gravity by bending your knees slightly throughout the entire movement.
- Puck placement: Place the puck near your front foot (the one closest to where you’re trying to go) before starting the move.
- Grip: Hold your stick firmly but not too tightly – remember that flexibility is key when executing quick movements like a toe drag.
Step 3: Execute the Toe Drag Move
Moving through these steps quickly will ensure success in performing a smooth toe drag:
- Pull back on your top hand and push forward with the bottom hand to cause the blade of your stick to roll over the puck so you can pull it toward your body.
- Use the toe of your blade as you pull the puck in to maintain control and guide its movement.
- Get control of the puck by rolling it back onto the flat part of your blade. Then quickly accelerate past your opponent.
How Do I Get Better at Toe Drag?
You need to practice regularly and focus on the fundamentals to improve your toe drag skills. The following tips will help enhance your toe drag technique and become more confident executing the move during games.
Start with a Proper Grip
The bottom palm should be set at the midpoint of your stick to allow for better control when performing a toe drag.
Continue Improving Your Stickhandling Skills
Because a successful toe drag requires excellent stickhandling abilities, make sure to practice drills that focus on quick movements and maintaining puck control.
Use Visual Cues to Improve Timing
Timing is crucial with the toe drag – watch videos of professional players doing toe drags or ask an experienced teammate or coach to help you perfect your technique.
Tips for Practicing Toe Drags:
- Mirror Practice: Stand in front of a mirror and perform slow-motion toe drags without skates on to get familiar with body positioning.
- Dryland Training: Practice off ice using a ball or puck designed specifically for dryland training.
- Incorporate Obstacles: Set up cones or other obstacles as defenders while simulating game situations.
- Practice with Different Speeds: Vary the speed of your toe drags to develop versatility and adaptability during games.
Strengthen Your Wrist and Forearm Muscles
A strong wrist snap is crucial for a successful toe drag. Incorporate exercises like wrist curls, grip strengtheners, or resistance bands into your workout routine to enhance your wrist strength.
Analyze Your Performance
Film yourself practicing toe drags and look at the footage to try finding areas or form that need improvement. You can also ask for feedback from coaches or teammates who can help you improve your technique.
Hockey Toe Drag FAQ
How do you teach a toe drag in hockey?
To teach a toe drag in hockey, use the following tips:
- Start with stationary practice and have players put their stick on the ice and the puck at their side.
- Have them pull the puck toward their body using only the toe of their blade.
- As they become more comfortable with this motion, have them try doing the move while going forward slowly.
- Gradually increase speed during practice drills or scrimmages until players feel ready to incorporate their new move into game situations.
How do you defend a toe drag in hockey?
Anticipation and maintaining proper positioning are key to defending against a toe drag. Keep these tips in mind when facing an opponent who’s about to attempt a toe drag:
- Maintain good gap control between yourself and your opponent. This gives you enough time to react if they attempt a deke like the toe drag.
- Focus on their chest rather than following the puck to help maintain proper positioning.
- Poke check strategically – aim for where you anticipate your opponent’s next move to be instead of lunging blindly for where they currently are.
- If possible, force your opponent toward less dangerous areas on the ice by angling them away from high-scoring zones.
What is the best hockey curve for toe drags?
The best hockey curve for toe drags is subjective and depends on an individual player’s preference.
However, a stick with a more open face and deeper curve may provide better puck control during toe drags.
What is a backhand toe drag?
A backhand toe drag is similar to the standard forehand version but executed using the backside of your blade. This hockey move can be incredibly deceptive because it requires less obvious movement from your hands or arms, making it harder for defenders to anticipate.
Want to learn more about hockey moves? Read our article “7 Hockey Moves Every Player Should Know” here.
Equip Yourself with the Best Skates to Master Your Toe Drag
Now that you understand the hockey toe drag and know how to improve your skills, having the right hockey gear is essential.
Your equipment can make all the difference on the ice – and HockeyMonkey offers top-of-the-line skates to help you glide effortlessly as you perform your toe drags. We also have the best sticks on the market. Don’t settle for less when it comes to your equipment. You’ll find everything you need at HockeyMonkey – browse our full selection of hockey skates and more today.
How to Toe Drag – Off ice Tutorial
I have had a tonne of requests from the subscribers of how to hockey to teach them how to toe drag. I wanted to wait until the ice is in, but I know a few good ways to practice the toe drag off ice so I thought I would write this article (and make a cool video!).
Why Use a Toe Drag
In my article and video on how to stickhandle I mention that to be master of the puck, you need to be able to control the puck around your entire body, and also have the ability to move the puck from side to side, and front to back in any situation. Perfecting the toe drag will give you the ability to move the puck quickly backwards and forwards, and side to side no matter where it is.
Another great advantage to the toe drag is to use it to deke out the opposition or the goalie. There are a number of situations where a quick toe drag can be the best (and prettiest) way to get around the defense. Sometimes the defensemen thinks you have no room to move the puck, but by using the toe of the stick to pull the puck backwards you give yourself more room move the puck.
Then you can move it over and up and blow past the D (and look awesome!)
How To Toe Drag
I was hesitant to show people how to toe drag off-ice. I learned how to toe drag with a stickhandling ball, I had it perfected, then I stepped onto the ice and tried it with a puck….not good. The puck flew backwards…over, and over, and over. I did have the general motion down, but I had to adjust a bit to get it to work on the ice. I think the biggest problem was that I learned with a ball, and with a lot of friction, but on the ice you use a puck, and there is very little friction. So my best recommendation for learning to toe drag off-ice… get a green biscuit, and a hockey shooting pad (I really like the roll up shooting pad don’t forget to use our coupon)
The Green Biscuit is a great puck to use to perfect the toe drag off-ice.
The toe drag is pretty simple on paper (or computer screen), but actually getting it down is tough, here is how to toe drag
- Roll your wrists to roll the blade of the stick over, so the toe of the blade of the stick is pointing down
- Catch the puck with the toe, and pull it backwards (or sideways if the puck is to your side)
- As the puck is coming backwards, roll your hands back and catch the puck
Make sure you have the toe centered on the puck, otherwise it will slide to the side.
This is the most basic toe drag, once you get better you can use the toe drag to move the puck straight back, in a J motion, or a wide U to pull the puck from one side of your body, all the way to the other.
How To Toe Drag Video
In this video I show you the toe-drag, and how I practice it off the ice. I also show you in detail how you can learn to toe drag off ice with a detailed step-by-step guide. If you have any problems you can leave a comment in this article, on the video, or on our facebook page
If you like this video you can subscribe to our channel on Youtube
how to deke how to stickhandle stickhandle stickhandling toe drag
Healthy foot exercises
Who doesn’t know this feeling?.
.. Leg pain after a long day at work or exercise!
Our feet are designed to run barefoot on natural surfaces. Instead, day in and day out, we actually shackle our feet with shoes that reflect the latest fashion trends much more than the needs of our feet.
Just 15 minutes a day is enough to relieve tension and stress and keep your feet healthy.
Do something useful for your feet, and they will certainly thank you!
C-arm
In a sitting position, grasp the foot with both hands. Grasp the knuckle of the thumb with one hand and the little finger with the other hand, as shown. Then start massaging two fingers in a circular motion towards each other. As you move, you kind of create a C-shaped symmetrical arc.
Repeat the exercise 10 or 20 times. Tip: do gentle movements! This is a fairly easy exercise!
Duration: 3-5 minutes on average
“Tear the newspaper”
Sit on a chair and place both feet on the newspaper.
Grab the paper with your toes and slowly tear the newspaper, page by page. Try to tear the newspaper into small pieces.
Do the exercise for at least 1 minute
Attention: this exercise is quite difficult!
Foot spiral
Sit comfortably on the floor so that your right foot and lower leg form a right angle. Grab your toe with your right hand and your heel with your left. Then begin to perform the movement, as if you were squeezing out a wet towel. “Twist” the heel inward and the foot outward.
Repeat the exercise 10-20 times or more.
Attention: move gently and do not twist the foot when resistance occurs.
This exercise is quite difficult to perform!
Duration: about 5 minutes
Towel Lift
Sit on a chair and place one foot on a towel. Then grab the towel with your toes and try to lift it up. Do the exercise for at least 30 seconds.
Tip: The exercise can also be performed while standing, which increases its difficulty.
This exercise is quite difficult!
Duration: 30 seconds
Knot
Take a rope of medium thickness about a meter long. Lay the rope on the floor and sit on a chair in front of the rope. Pinch both ends of the rope with your toes. Try tying a knot.
Do the exercise for 5 minutes.
Attention: this is a rather difficult exercise!
Duration: about 2 minutes
Ball Massage
Actively roll the tennis ball forward/backward with the sole of your foot. Engage the entire surface of the foot: from the forefoot to the heel. The duration of the exercise is optional (as long as you feel comfortable).
Tip: You can also do this exercise while sitting. When using a special massage ball, the impact on the foot is enhanced.
Duration: about 3 minutes
Letter Writing
Lay a piece of paper on the floor. Sit on a chair and place one foot on a piece of paper.
Grab the handle with your thumb and forefinger. Try to write any word, for example, “Mom”.
Perform the exercise for at least 3-5 minutes.
Attention: this exercise is quite difficult!
Duration: 3-5 minutes
Fingertip Stand
Place your feet parallel to each other. Stand on your toes and alternately lower your left and right heels 10 times, without touching the heel to the floor.
Tip: Do this exercise regularly several times during the day, for example when brushing your teeth. The exercise is quite difficult.
Duration: about 3-5 minutes
Ball rolling
Sit on a chair and lift your feet. Grab a medium-sized ball between your feet. Hold the ball firmly with your feet. Start moving the ball from the ball of your fingers to your heels without letting it fall. Shake your legs well at the end of the exercise.
Repeat the exercise 5 times.
Attention: this is a rather difficult exercise!
Duration: 3-5 minutes
“Wrinkle and smooth the paper again”
Sit on a chair with a piece of paper in front of you.
Put your feet on a piece of paper. Then, with both feet, try to crush the piece of paper as hard as possible. Next, unfold the piece of paper with your feet and try to smooth it as much as possible.
Repeat the exercise twice.
Attention: this exercise is quite difficult!
Duration: 1-2 min.
Article editor – Valery Vladimirovich Shevchenko
Head of the training center “Ortix”, medical expert in the field of orthopedic products, general practitioner
Back to the list of all articles →
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Hallux valgus – treatment, symptoms, causes, diagnosis
Hallus valgus is a condition in which damage to the joint of the big toe occurs. with the formation of bone growth in response to injury. In fact, Hallus valgus is not just a reaction to an injury. Interestingly, this disease almost never occurs in cultures that do not wear shoes. Tight shoes, such as high heels and cowboy boots, can contribute to the development of hallux valgus.
Wide shoes, with room for the toes, reduce the chances of deformity developing, and help reduce irritation to the area of bunion, if present.
The term Hallus valgus actually describes what happens to the big toe. Hallus is the medical term for the big toe, and valgus is the anatomical term for deformity that deviates from the midline of the body. So valgus deformity of the big toe beyond the foot. As this process progresses, other changes appear. One of those changes is that the bone that sits above the big toe, the first metatarsal, begins to lean more in the other direction. This bone is called the primus varus. Primus means first metatarsal, and varus is a medical term that means that the deformity is manifested by a deviation from the midline of the body. This creates a situation where the first metatarsal and the big toe now form an angle with respect to a line running along the inner edge of the foot. The bunion that develops first is actually a reaction to shoe pressure.
At first, the reaction to trauma is an area of irritated, edematous tissue that constantly rubs between the shoe and the bone located under the skin. Over time, the constant pressure can cause the bone to thicken, which increases swelling and further friction against the shoes.
Causes
Many foot problems are the result of abnormal pressure or friction. The easiest way to determine the presence of the consequences of pathological pressure is to examine the leg. The leg is a hard bone covered with skin. In most cases, symptoms develop gradually as the skin and soft tissues absorb the excess impact on the leg. Any bone protrusion or injury exacerbates the effects of the injury already present. The skin reacts to friction and pressure by forming calluses. The soft tissues under the skin react to excessive stress. Both the callus and the thickened soft tissues under the callus become painful and inflamed. Pain is relieved by pressure reduction. Pressure can be reduced from the outside with looser shoes or from the inside by surgery and removal of excess tissue.
Risk factors
- Shoes affect the incidence of hallux valgus (lower in adults who do not wear shoes). However, this does not mean that only shoes cause this disease. Constricting shoes can cause pain and pinching of the nerves in the foot along with the formation of hallux valgus. Fashionable shoes can be too tight and too narrow for the ‘leg to look aesthetic.’. High heels put more stress on the foot, further exacerbating the problem. Moreover, fashion trends are followed not only by young people, but also by persons of the older age group. Risk factors can be divided into the main ones:
- Higher likelihood of hallux valgus in females. Shoes may be the cause.
- Ballerinas who spend a lot of time on the blocks while dancing on their toes and thus can be expected to be more likely to develop hallux valgus
- Age. The incidence of deformity increases with age, with rates of 3% in people aged 15-30, 9% in people aged 31-60, and 16% in those over 60 1
- Genetic factors are of some importance
- Associated diseases
There are specific causes of biomechanical instability, including neuromuscular disorders.
This may be due to arthritis of various kinds. These associated diseases include:
- Gout.
- Rheumatoid arthritis.
- Psoriatic arthropathy.
- Articular hypermobility associated with diseases such as Marfan’s syndrome Down’s syndrome.
- Multiple sclerosis.
- Charoth disease
- Cerebral palsy.
Symptoms
Hallux valgus symptoms are mainly due to bunion. Bunion of the big toe is quite painful. With severe valgus deformity of the big toe, a cosmetic problem also appears. In addition, the selection of shoes becomes difficult, especially for women who want to be fashionable and for them wearing fashionable shoes becomes a real challenge. Finally, the increase in deformity begins to move the second toe and the second toe may rub against the shoe.
Diagnosis
Case history
- The patient may experience pain in the big toe when walking or moving. This may indicate degeneration of the intra-articular cartilage.
- Pain may be aching in the area of the metatarsus due to wearing shoes. Possible increase in deformation. .
- It is necessary to find out what physical activity increases pain and what relieves pain (maybe just removing shoes).
- History of injury or arthritis.
- Quite rarely, there is sharp pain or tingling in the dorsal region of the bursa of the thumb, which may indicate traumatic neuritis of the median dorsal cutaneous nerve.
- The patient may also describe symptoms caused by the deformity, such as painful second toe, interdigital keratosis, or ulceration.
External examination
- Observe the patient’s gait. This will help determine the degree of pain and possible gait disturbances associated with leg problems.
- Position of the big toe in relation to the other toes. Distortion of the joint can be in different projections..
- Prominent joint position. Erythema or swelling indicates shoe pressure and irritation.
- Range of motion of the big toe in the metatarsal joint. Normal posterior flexion is 65-75° with less than 15° plantar flexion. And it is necessary to pay attention to whether there is pain, crepitus. Pain without crepitus suggests synovitis.
- Presence of any keratosis that suggests abnormal rubbing from abnormal gait ..
- Associated deformities may include hammer toes and flexible or hard flat feet. These deformities can cause more rapid progression of hallux valgus as the lateral support of the foot is reduced.
Changes in movements in the joint of the big toe:
- Increased abduction of the big toe in the transverse and frontal planes.
- Increase in the average prominence of the toes.
- Change in posterior flexion of the joint.
In addition, attention should be paid to the condition of the skin and peripheral pulse. Good blood circulation is especially important if surgical treatment is planned and normal healing of the postoperative wound is necessary.
Examinations
X-rays will show the degree of deformity and may indicate subluxation of the joint. If necessary, to rule out other diseases, a CT scan may be ordered. Ultrasound is necessary for the study of blood vessels in case of suspected circulatory disorders. Laboratory studies are prescribed if necessary to exclude associated diseases and in preparation for surgical treatment.
Treatment
Conservative Treatment
Treatment for hallux valgus almost always begins with comfortable shoes that do not cause friction or strain. In the early stages of Hallus valgus, wearing shoes with a wide front can stop the progression of the deformity. Since the pain that results from bunion is due to pressure from the shoe, treatment focuses on relieving the pressure that the shoe puts on the deformity. Wider shoes reduce pressure on the bunion. Big toe pads can reduce pressure and friction from shoes. There are also numerous devices, such as spacer orthotics, that allow splinting of the toe and change the load distribution on the foot.
Medication and physical therapy
Non-steroidal anti-inflammatory drugs and physical therapy may be prescribed to reduce inflammation and relieve pain. In addition, injections of corticosteroids are possible. Long-term physiotherapy has not proven to be therapeutically effective.
Orthopedic products
It is possible to use various orthopedic products (arch supports, toe correctors, interdigital ridges). The use of orthopedic devices helps to stop further deformity in the early stages. With severe deformity, the use of orthopedic products can only slightly reduce pain. Individual insoles help to correct the damaged arch of the foot.
If the deformity is caused by a metabolic disorder or a systemic disease, then it is necessary to carry out treatment aimed at correcting the underlying disease with the involvement of a rheumatologist or endocynologist.
Surgical treatment
If all conservative measures fail, then a decision is made on surgical treatment.
Currently, there are more than 100 surgical techniques for the treatment of Hallus valgus. The main tasks in surgical treatment are as follows:
- remove bunion
- reconstruct the bones that make up the big toe
- balance the muscles around the joint so that there is no recurrence of the deformity
Bump Removal
In some mild cases of bunion, only the lump on the bursa can be removed during surgery. This surgery is performed through a small incision on the side of the leg in the area of the big toe bunion. Once the skin is cut, the growth is removed using a special surgical chisel. The bone is aligned and the skin incision is sutured with small sutures.
Big toe reconstruction is more likely to be needed as well. The main decision to be made is whether the metatarsal should be cut and reconstructed as well. The angle between the first metatarsal and the second metatarsal is important to this question. The normal angle is about nine or ten degrees.
If the angle is 13 degrees or more, then the metatarsal bone most likely needs to be cut and reconstructed. When a surgeon cuts and repositions a bone, this is called an osteotomy. There are two main methods used to perform osteotomy and reconstruction of the first metatarsal.
Distal Osteotomy
In some cases, the distal end of the bone is cut and moved laterally (this is called a distal osteotomy). This effectively reduces the angle between the first and second metatarsal bones. This type of surgery usually requires one or two small incisions in the leg. Once the surgeon reaches a satisfactory position of the bones, the osteotomy is accompanied by fixation of the bones with metal pins. After the operation and healing, the pins are removed (usually they are removed 3-6 weeks after the operation).
Proximal osteotomy
In other situations, the first metatarsal is cut at the proximal end of the bone. This type of surgery usually requires two or three small incisions in the leg.
