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Big Toe Pain

Big toe pain can be a result of injury or other medical conditions. These may include arthritis, fractures, and gout. These and other causes such as sesamoiditis, ingrown toenails, and broken toes will require clinical evaluation.

Pain at big toe joint: Everything you need to know

  • Causes
  • Diagnosis
  • Treatment and relief
  • Prevention
  • Seeing a doctor
  • Summary

Activities of daily living and exercise will be very challenging if you have big toe pain. 

The metatarsophalangeal (MTP) joint attaches your big toe to your foot. This joint enables the toe to bend up and down. It also propels you forward by being an anchor/push-off point while walking and running.  

Conditions that affect the MTP joint explained above can cause pain and swelling around the big toe. This can limit movement at the joint and affect walking patterns and everyday activities. 

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Osteoarthritis at big toe joint:

Osteoarthritis occurs when cartilage wears down at the joints from overuse. When this form of arthritis occurs in the feet, it most commonly affects the MTP joint at the base of your big toe.  With time, osteoarthritis in the big toe will cause the cartilage to erode which in turn causes the bones to rub against one another. This frictional force causes pain and inflammation, which can affect walking. Bones spurs can also develop which are bony projections. Bone spurs and osteoarthritis can cause hallux rigidus of the big toe, which is limited movement of the big toe. 

Gout 

Gout occurs when uric acid crystallizes in the joints and is another type of arthritis. Uric acid is a waste product that passes out of the body in the urine. High levels of uric acid can cause crystallization to occur which is very painful. First symptoms of gout often occur in the big toe, which is accompanied by severe episodes of sharp pain and swelling of the area. Gout may also occur in other parts of the body. Lumps may form over time under the skin in affected regions.

Gout is a common form of arthritis that causes pain, swelling, and joint stiffness. It most commonly affects the big toe joint. Gout incidents can come on quickly and return again over time. Hypertension, cardiovascular, and metabolic disorders are all risk factors for gout to occur. It is most common to see gout in men, but women are more susceptible after menopause. 

Facts About Gout

  • Gout is caused by excessive uric acid in the bloodstream
  • Symptoms are due to crystallization of uric acid in the joints and the physiological response that follows
  • Mostly seen in the big toe joint
  • Can occur in the middle of the night and be very painful
  • Most cases are treatable with medication

Treatment

Most cases of gout are treated with medication. These medications will treat the symptoms of gout attacks, prevent future flare ups, and reduce the risk of complications such as kidney stones and tophi. These commonly used medications include anti-inflammatory drugs such as NSAIDs, colchicine, and corticosteroids. Inflammation and pain will be reduced by these oral medications. Other medications are used to reduce the uric acid production or improve the ability to remove uric acid. Without treatment, an acute episode of gout will peak between 12-24 hours after being initiated. Individuals can expect a recovery duration of 1-2 weeks without treatment. 

Tests and Diagnosis

Gout is not always easy to diagnose because its symptoms are similar to quite a few other conditions. Hyperuricemia commonly occurs in those with gout, but may not be present during a flare up. Also, most people with hyperuricemia do not develop gout.

A diagnostic test that doctors use is the joint fluid test, which extracts fluid from the affected joint via needle. The fluid is reviewed to identify if urate crystals are present. Joint infections can also cause symptoms similar to gout, which allows doctors to look for bacteria when performing the joint fluid test. Fluids may need to be sent to the lab for further examination, which may take a few days.

Blood tests can be used to measure the level of uric acid present in the blood. People may develop symptoms of gout without increased levels of uric acid. Your doctor may also search for urate crystals around joints or within a tophus via ultrasound scan. X-rays do not detect gout, but can rule out other causes.

Broken Toe

Many injuries of the feet can have an affect on the big toe joint. Stress fractures may result from overuse which causes a small crack to develop from the forces placed on it. We can X-ray on the premises, instantly

Sprains are classified as ligaments in the toe that become torn or stretched. Sports injuries such as turf toe can cause sprains to occur due to excessive pressure on the toe. All the injuries of the toe can cause pain swelling to occur. 

Bunion

Bunions are bony lumps that develop along the inner side of the MTP joint. Pain and swelling can occur around the big toe. Stiffness and limited range of motion may also be present. The big toe may start to point toward the second toe, which is known as hallux valgus deformity. Picking shoes and walking are very difficult for someone with this condition. They may occur in anyone, but those who wear tight shoes are at greater risk of developing bunions. 

Bunions are deformities of the joint at the base of the big toe. This causes the joint to protrude out and show a visible bump on the side of the foot which is affected. Bunions cause the toe to point in the opposite direction with the potential to overlap onto the toe beside it. 

Shoes often put a significant amount of pressure on the protruding joint which may cause a fluid filled sac to form in the joint known as a bursa. 

Symptoms

Bunions are commonly known to cause swelling, inflammation, and pain. The big toe may point inward while the joint at the base points outward. 

Treatment

To reduce symptoms, a person should look for new shoes that have little to no pressure on the big toe joint. Wide and flexible soles are what to look for. 

Other treatment options include the following:

  • OTC bunion pads
  • NSAIDs or pain medications
  • Warm soaks 
  • Ice
  • Massages or manual therapy

Other Causes

  • Nail Infections
  • Raynaud’s disease
  • Morton’s neuroma
  • Rheumatoid Arthritis

Sesamoiditis

Inflammation of the sesamoid bones and surrounding tendons due to overuse is known as Sesamoiditis. These bones in the foot are beneath the MTP joint, and tendons attach to them to support movement in the area. This condition can cause pain at the base of the big toe and may also lead to swelling, bruising, and limited range of motion. 

Diagnosis

Your doctor will perform a physical examination and ask you about your symptoms, lifestyle, and medical history. Range of motion and flexibility may be tested, and the area will be observed for bone spurs and swelling. X-ray may be needed, and further testing such as blood tests may be given to diagnose gout.

Treatment and Relief

Treatment types will vary depending on the cause of big toe pain. Your doctor will likely recommend pain relievers such as NSAIDs. Swelling may be reduced by these medications. In rare cases, your doctor may prescribe corticosteroids. Changes in activity and lifestyle may be recommended as well. Wearing shoes with exra space for your toes is an example of a lifestyle change. 

Avoid the activities that caused your injury. Refraining from sports that caused your injury is necessary.Some scenarios may benefit from losing weight to reduce pressure on the toes. Other conditions such as arthritis and gout require  specific treatment such as physical therapy. Surgery may be needed in some cases to remove a bunion or repair joint damage. 

Prevention

The following tips are recommended to prevent pain at the big toe joint:

  • Maintain a healthy weight
  • Exercise regularly without excessive strain on the MTP joint
  • Avoid wearing tight footwear around the toes

When to see your doctor

Mild pain or pain that gets better over time does not usually require a visit to the doctor. Sprains can typically heal on their own after rest. If the pain doesn’t improve after three days, it may be best to schedule an appointment to see your doctor. If your pain is severe or sudden and unexplained, contact your doctor.

Summary

Pain in the joint of the big toe may be due to trauma, chronic conditions, or pressure built up over time due to activities performed. The underlying cause is usually treatable. Rest, pain medication, and time can heal injuries as well. Conditions such as osteoarthritis will require long-term solutions. Simple lifestyle changes such as wearing appropriate footwear can reduce the risk of toe injuries. Speak to your doctor if your pain does not resolve over time. 

Symptoms

Pain while walking or being active are the most common symptoms due to the pressure on the feet and big toes. The following symptoms may also occur:

  • Swelling near the big toe joint
  • Bump that appears on the top of the joint
  • Difficulty moving the big toe

Treatment

The following treatment options for hallux rigidus include surgical and nonsurgical treatments.

Nonsurgical:

  • Ice or heat
  • Pain medication
  • PRP injections
  • Changing footwear

Surgical:

  • Fusing the joint
  • Removal of bone spurs
  • Joint replacement or resurfacing

Ingrown Toenail

Ingrown toenails cause pain and discomfort in the big toe. It may occur when a person incorrectly cuts their toenail too short or curves it in too far. Tight shoes may add to the problem and cause extra pain in the case of an ingrown toenail. 

Symptoms

  • Hardness, swelling, or tenderness of the toe
  • Soreness
  • Skin discoloration
  • Discharge of pus from the area

Treatment

Treatment options begin with nonsurgical methods, but doctors may perform surgery for persistent ingrown toenails. Nonsurgical option include:

  • Pain medication such as NSAIDs
  • Warm bath soaking 3-4 times daily
  • Keeping the feet dry by consistently changing socks
  • Comfortable footwear

Surgical options include:

  • Partial or full removal of the nail
  • Permanent nail removal for chronic cases

Turf toe

turf toe

Turf toe is an injury that occurs during sporting activities and it is an injury to the joint of the big toe. This injury occurs due to repetitive bending to the big toe or jamming it. Constant jumping or running can cause this to occur. Athletes on artificial turf are more susceptible to this. 

Turf toe is identified as pain at the base of the big toe. This is an overuse injury that is commonly caused by a strain. Turf toe may also be a form of sesamoiditis or a sesamoid fracture. 

Symptoms

Turf toe is most commonly caused by repetitive movements. Pain and swelling will increase over. Loss of mobility and swelling in the joint may also occur.  

Treatment

Avoiding the physical activity or movements that are irritating the region is the best option for treatment. Treatment also should be accompanied by rest, ice, compression, and elevation (RICE). Your doctor may want you to wear less flexible shoes when participating in physical activities. Surgery is typically the last resort to treatment but may be recommended.

Toe fractures

Toe fractures can occur in any bones of the toes. Minor fractures may only need rest, ice, and pain medication. More severe fractures may need surgical procedure. Consult your physician if you suspect a fracture. 

Toe sprains

Toe sprains may occur when you jam or stub your toes, which damages the tendon or soft tissues. If a fracture is absent, the pain and swelling should go away within a few days.  

Hallux rigidus

Hallux rigidus, also known as “stiff big toe,” is a form of arthritis at the base of the big toe. Pain and stiffness of the joint may worsen over time. Treatment involves pain relievers and PT exercises. Surgery may be required in some cases.

Corns

Corns are thick buildups of tough skin on a point of irritation or pressure on the feet or toes. They sometimes have a horn-like appearance. Calluses are wider areas of tough skin that build up as a result of irritation or pressure. Both are most commonly caused by improper footwear. 

To treat them:

  • Wear better-fitting shoes
  • Soak the foot and use a pumice stone to wear down the extra skin

Sesamoid fracture

Sesamoid fracture is a break of the small bones that are embedded in tendons attached to the big toe. Pain in and around the big toe is the main symptom of this form of fracture. . 

To treat it:

  • Rest, ice, and elevate your foot.
  • Wear stiff-soled shoes or foot pads to relieve pressure.
  • Take pain relievers.

If you’re still in pain, talk to your Podiatrist.