Ode to the great toe

I am a long-time proponent of equality and long-time opponent of discrimination. In all aspects of life. Because of these strongly-held values, reinforced over 30-odd years practicing medicine, I still do not understand why certain organs are viewed as so superior to others. Don’t get me wrong, I have nothing against the heart, or the brain, or the liver. They serve us well. I value them in my own body, and I have worked diligently over the years to maintain their health in the bodies of others.

But why are other important organs looked down upon? Why does the pinna receive only fleeting praise? Why do the para-aortic lymph nodes merit only glancing notice during CT scans of the abdomen? And why – arriving at the subject of this essay – is the great toe treated with such disdain? Why, I ask you?

The great toe is surely one of the most underappreciated organs in our body. It is just an appendage, after all, an afterthought. A side show to the main event. The great toe is one of those organs – think appendix or tonsils – that seems to do very little good but can do harm. It can cause distress when its nail becomes ingrown. It can be a mocking participant in gout attacks. When the nail is infected by fungus, it can be unsightly if not downright ugly. And do not get me started on the subject of bunions.

So why do I rise now to sing the praises of the great toe? Thank you for asking. I developed a new appreciation for the miracle of the great toe after a 50 pound marble table top hit my right great toe edge-on one month ago. As would be expected, the resulting energy transfer from marble slab to toe led to the following: a comminuted fracture of the distal phalanx, a laceration of the plantar aspect of said toe, a nail which was torn away from its base, extensive bleeding, and an onslaught of electrical impulses sent via afferent nerve fibers to the spinal cord, then to my brain. It was a memorable event.

I have been lucky to be able to avoid assuming the role of patient for most of my life. But this time, I opted to go to the ED and place myself and my great toe at the mercy of another physician. And I’m glad I did. A set of xrays, a digital block, a thorough cleaning, and nine stitches later, I felt great. At least until the digital block wore off (more on the miracle of lidocaine at some future time). The four weeks since the mishap have made me more seriously appreciate and love my great toes. They do so much. They assist my balance. They help me walk. They enable me to ride my elliptical four times a week. They make possible the wearing of shoes. They are first responders when encountering the legs of furniture or onrushing grandchildren. When functioning normally, the great toes are modest. They do not loudly advertise their importance. No wonder they are so often taken for granted. But when they malfunction, their value can no longer be denied.Their utility and importance for activities of daily living gains clarity.

Trust me on this.

My take-home message to all clinicians? Do not neglect the far corners of the human body. Do not disparage or disrespect those organs which may not have acquired the label of vital organ. All are important in their own way. Each should be treated with equality and appreciation. Let me go further. Let me advocate that all the body’s organs be viewed with compassion. By all clinicians.

There, I’ve said my piece. And I hope great toes everywhere will feel more pride for all they do.

Richard Fleming, MD

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