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I was told by a patient that a prominent (vascular) surgeon told him that toes aren't necessary for walking. I replied that if toes aren't then feet aren't either. Am I correct?

 

My opinion is that toes are fore distributing force on the forefoot. This is especially important after heel lift in gait. If you look at the problems that people have when they have severe claw toe contractures, you see mostly high forefoot pressure problems. I've seen some patients who have had cosmetic 5th toe amputations and they seem to function just fine.

On the other extreme of the question, you can "walk" with a peg leg. So, the foot isn't necessary for walking. However, you can balance better and get more propulsion with an intact foot. Certainly a higher quality of life. Does your prosthesis need toes? (Oscar Pistorious)

I guess how much of your foot you get to walk on depends on your vascular surgeon

Eric

 

Thanks Eric.

 

How is the windlass supposed to work without the toes?

 

No, your both completely bonkers.

God didn't us feet & toes for the fun of it.

 

I would argue that the proximal part of the first phalanx, particularly the more medial ones, are necessary for a windlass, beyond that, they are redundant. anecdotal evidences from a friend with a flymo amputation at that level, and a Himalayan frostbite victim at the same level, supports this hypothesis.

 

As Eric stated, one can certainly "walk" without toes, or without feet, for that matter. People with wooden peg legs can "walk". However, the efficiency of walking and the ability to walk long distances without foot injury are certainly improved with the presence of digits.

Why?

1. The digits reduce the magnitude of ground reaction force (GRF) plantar to the metatarsal heads in late midstance and propulsion due to their load-sharing function in the forefoot.

2. The digits increase the propulsive moment arm for the foot and ankle during propulsion.

3. The digits serve as important insertion points for the central component of the plantar aponeurosis, flexor hallucis longus and flexor digitorum muscles, in addition to many of the plantar instrincis muscles, all of which share the function of creating a forefoot plantarflexion moment and thus helping to prevent longitudinal arch flattening during weightbearing activities.

4. The digits serve as important insertion points for the extensor hallucis longus and extensor digitorum longus muscles, both of which are important ankle joint dorsiflexors during weightbearing acivities.

5. During flatfooted and tiptoe standing positions, the digits increase the anterior surface area of the foot which improves the ability of the individual to balance the center of mass over the plantar foot.


and

6. Vibram Five Fingers would need to be renamed Vibram No Fingers if we didn't have toes.:drinks

 

I agree. The windlass adds to the overall ability of the foot to resist midfoot dorsiflexion under load. There are other structures that resist forefoot dorsiflexion that will maintain an arch under some load. (plantar ligaments).

It does raise a question, what happens to the distal attachment of the plantar fascia after the healing of an amputation. Does the scarring provide sufficient attachement to support some load in the plantar fascia?

Eric

 

Point taken. All I can tell you is that my friend with the flymo amputation, once had got used to the idea, said he didn't miss his hallucial distal phalanx and distal part of the proximal phalanx at all. He was a vet, so did appreciate at least some part of these arguments.

 

Or they might be called "traditional" shoes.

 

I had a patient years ago that had had ALL 10 toes amputated back in the 1960's (she said that it was because of 'bunions and arthritis'??)
Anyway, she moved (I wouldn't say walked) by lifting her feet up and down (with high knee lift, sort of like she was marching).
Consequently, she didn't get anywhere fast and developed HUGE callouses under both heels and on the forefoot areas.

I now have a lot of patients with hallux amputations and most 'walk' or ambulate quite well but at some cost-callouses do develop and some have muscular aches and pains in the affected (or sometimes non affected limb) where some form of compensation occurs for the lack of the hallux.

(BTW, why are vibrams called five fingers?? Why not five toes?? I never did get that.....)

 

Apparently, in Italian, the same word is used for fingers and toes. When Vibram, an Italian company translated to English they had a 50/50 chance of getting it right. I suppose they could have corrected their translation error but it kind of goes along with the rest of the angst people have about the shoes.

Playing it safe, taking the middle ground is boring. Without controversy, it is hard to make progress or be innovative.

The extreme simplicity of the Vibram FiveFinger is what gives it, its brilliance and genius. For those who don't get it, they just can't see beyond their own built in expectations.

Dana

 

Actually, both Spanish and Italian use the same word for fingers and toes ("dita" in Italian and "dedo" in Spanish). Therefore, "five fingers" translated into either Spanish or Italian could mean either five fingers or five toes. At least that is what my Spanish/Italian interpreters tell me.

 

Ok, now I think about it, my Italian patients always point to the sore 'finger' on their foot!

(didn't realise Vibram was an Italian company)

 

Started by Vitali Bramini. VI-tali BRAM-ini = VIBRAM. His sole was first patented in 1937. Needless to say VIBRAM has been around for a few years, is THE name in hiking boot and outdoor shoe soles and will continue to be around for years to come.

 

Kevin, good post. I would agree toes are important. I wonder what it would be like to wear a shoe to walk or run in that promotes and encourages the use of your toes.

Dana

 

I not sure the Vibrams actually do "promotes and encourages the use of your toes". They could actually inhibit toe function. See this thread: Vibram Five Fingers and Plantar Plate Dysfunction

 

Craig, maybe true for some of the models of VFF, they have a range of soles with varying flexibility so all VFF are not created equally. The TrekSport is pretty stiff in comparison to the KSO, Bikila, Classic and now EL X. "Minimal" shoes with a "mono" toe also are designed to "promotes and encourages the use of your toes". In comparing VFF to minimal shoes with a roomy toe box, I would definitely agree that it is easier to move your toes around in the single toe boxed minimal shoes. I suppose the increasing level of stiffness across the various models of VFF might begin to affect some people.

As an anecdotal, N=1, comment, when I look at the wear patterns on the VFF shoes that I use, compared to the wear patterns on my conventional shoes, there is considerably more wear on the toes of my VFF. When I focus on what my feet are doing while I'm running on the trails I use, when climbing hills, I can feel my toes actively flexing to grab onto the ground as I'm climbing. That really doesn't happen when wearing conventional shoes.

Dana

 

In addition to the excellent posts, there is one more function of the toes (or digits if you are speaking a Romance language).

It is the proximal phalanx that is in contact with the ground at propulsion and not the metatarsal heads.

At propulsion the frictional force between the metatarsal heads and the ground would tear up the skin. The arrangement with the proximal phalanx with ground reactive force and the metatarsals within the proximal phalanx (and consider that the sesmoid bones are extensions of the proximal phalanx) allows for the frictional force to be absorbed at a joint.

Regards,
Stanley

 

That mandates mostly a great toe which I believe is what is really necessary.

Patients with hallux amputations have major gait and balance disturbance. Those who lose a lesser digit, or two do fairly well.

Those who lose more have concomittant LOPS, PAD, metabolic and neurolical disease and have many, many reasons for poor gait and balance.

In addition, toe stuffers for lesser toes work well in re-establishing plantar plate function and better gait. Hallux stuffers do not substitute for a functional hallux IMHO.

Dennis