Foot and Ankle Anatomy
Toe curling happens because the muscles that bend the toes down our over active. Some of the muscles that bend the toes down also point the ankle and turn the foot inward (posterior tibialis). This is important to note because all of these muscles need to be included in the stretching program.
What Causes Curled Toes after a Stroke?
There are two main reasons why the toes may start curling after a stroke. First, it may be due to a normal balance response reaction that is “out of wack”. What I mean is that under normal conditions the intrinsic foot muscles assist the body to maintain balance. However, when normal balance responses are impaired, these muscles might become over active in an effort to keep the body upright.
Another reason the toes may curl is due to spasticity. Spasticity in gastrocnemius, soleus, and posterior tibialis cause the foot to point down. These muscles are in close proximity to the muscles that bend the toes down. And in fact the posterior tibialis runs along the bottom of the foot and is somewhat attached to the intrinsic foot muscles. So when this muscle develops spasticity, it may also contribute to toe curling.
What is the Treatment for Curled Toes?
Whether your toes are curling as a result of an abnormal balance response reaction or due to spasticity, the treatment exercises are going to be the same. Treatment includes a combination of stretching, strengthening, and weightbearing.
Stretching is the most critical part for fixing or minimizing toe curling. Involuntary muscle contractions are more common when muscles are under more tension. Stretching helps to lengthen these muscles which will reduce this tension and minimize the occurrence of involuntary contractions. As I have already mentioned, ankle spasticity is one of the main reasons that might cause toe curling. Therefore It is important to stretch the ankle as well as the foot.
In order to stretch the toes, you will first need an incline board with something on it that can extende the toes. Here is a DIY version that I use in my clinic.
What you will need:
- A cutting board (or anything flat that is very sturdy and thin)
- 2 door stops
- a dowel (approx 1″) – I use a marker
Tape the two door stops to the bottom and place the dowel approx. 1/3 down from the top.
Stretching the Toe Flexor Muscles
Once you have an incline board with a dowel, now you are ready to lengthen all the muscles that run along the bottom of the foot and up the back of the leg.
Toe Separator Minimized Curled Toes
Spreading the toes helps to decrease abnormal tone in the foot. So, it is a good idea to add this while performing the stretch with the incline board. Toe separators can also be worn at night if you find that your toe curling occurs while you are sleeping.
Weightbearing is another great treatment for curled toes for two reasons. First, weightbearing helps to reduce/minimize spasticity. Weightbearing is also a great way to work on proper balance response reactions and minimize the abnormal response of toe curling. For this exercise, you start with your inolved leg on the incline board in the same position as the stretch shown above. Place a yoga block between your feet. Now try and shift all your body weight over the involved leg and tap the uninvolved leg on the block. The dowel will help to stop your toes from curling and “train” them to act appropriately.
Watch the full video explanation
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