Medical Question: I recently had a ski accident meaning i hit a tree
while traveling backwards (not on purpose of course). While waiting
for the ski patrol to collect me I lay as still as posisble in case of
any back trauma. I was asked by a passing doctor if I could feel my
toes wiggle, which i had already checked, but then he asked very
specifically if I could move all of them. I was wondering if there was
any medical reason he would ask if i could move all my toes, or was it
just his way of making sure i checked the movement of my toes again?

Hello russellmellors-ga!

I?m sorry to hear of your accident. I?m hoping that everything is much
better now. Luckily my husband is an osteopathic physician so I could
?consult? him about your situation. (Please note, however, that this
information in no way substitutes for medical advice from your own
personal physician). Using that information plus a web search, here is
what I found.

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SPINAL ANATOMY 101

To understand why this physician asked you to move all of your toes,
you should understand some of the basics about spinal anatomy. Most
skeletal muscles (like those responsible for moving your arms, legs,
toes, fingers, etc.) are controlled by nerves, which originally exit
the spinal cord between vertebrae. They are named for the level at
which they exit. For example the L4 nerve root exits below the 4th
Lumbar vertebrae. The L5 nerve root exits below the 5th Lumbar
vertebrae, and so on and so forth.

Basic explanations of spinal cord anatomy along with descriptions of
conditions such as disc herniation and pinched nerves can be found
here:
http://www.spine-health.com/topics/anat/a04.html


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TOE ANATOMY AND MOTION


There are a number of muscles that control toe motion. There is one
set that controls the big toe only, and another set that controls the
other four. I?ll list below the four major muscles involved, along
with their actions, which nerve controls each of them, and where in
the spinal cord these nerves arise.

Flexor Digitorum Longus: flexes toes downward, controlled by the
tibial nerve, arising in spinal nerve roots L5 and S1

Flexor Hallicus Longus: flexes big toe downward, controlled by the
tibial nerve, arising in spinal nerve roots L5, S1, and S2

Extensor Digitorum Longus: extends toes upward, controlled by the deep
peroneal nerve, arising in spinal nerve roots L4, L5, and S1

Extensor Hallicus Longus: extends big toe upward, controlled by the
deep peroneal nerve, arising in spinal nerve roots L4, L5, and S1

As you can see, there is a fair amount of overlap in the actual nerve
roots controlling the toes. The only variation is that the big toe
flexor has some nerve input from the second sacral nerve root (S2),
but it is unlikely that this would be an area affected by the injury
that you?ve described.
http://www.yinyanghouse.com/chinesetheory/acu_anatomy.html


Here is a pretty detailed table of muscles, their actions, and nerves
controlling them.
http://anatomy.med.umich.edu/musculoskeletal_system/leg_tables.html


Here is a site discussing weakness of the big toe related to direct
nerve injury. This would be another explanation of why one toe might
be weak while the others are not.
http://www.hwbf.org/hwb/conf/alex46/toe.htm


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So, in summary, it would appear that this ?passing physician? was
trying to determine, should there be a spinal cord injury or
impingement, where exactly it was located. Of course, there can be
injury to the nerve directly, which would be more likely to occur
during an orthopedic procedure, or after an injury to the leg
directly. In the case of a back injury, the nerve roots described
above are far more likely to be affected. I hope this helps. And I
hope you feel better (and can wiggle all of your toes)! If you have
need of any clarification, please let me know.

Sincerely, 
Boquinha-ga


Search strategy:

Online search
?Consultation? with my physician husband

Search terms:

anatomy toes nerves
spinal cord roots
toe weakness after injury

Many thanks for the answer, good detailed but understandable response!

Thank you very much for the 5 stars and the kind words!

Sincerely,
Boquinha-ga