Big Toe Joint Pain - Causes, Treatment & Prevention | Pain Care

Big Toe Joint Pain – Causes, Treatment & Prevention

Big toe pain is a very common symptom experienced by a lot of people. This is not unusual because much of our body weight is transferred to the big toe when we walk, run, and stand.

Although the joints and bones of the big toe are pretty small, the major role they play in weight bearing and movement makes them vulnerable to stress

Common Causes of Big Toe Joint Pain

Pain in the big toe joint can be caused by a number of factors and in seeking for relief from this symptom, one needs to identify correctly the underlying cause.

The following are common causes of pain in the big toe and ways to treat it.

Gout

Swollen Toe JointGout is a chronic inflammatory disease of joints caused by abnormal accumulation of uric acid crystals in the joint.

When purines and other nitrogenous substances in the body are broken down, they release uric acids.

In gout, the rate of breakdown of purines is abnormally excessive, resulting in accumulation of uric acids in the blood, these uric acid crystals ultimately get deposited in joints.

Gout is a common cause of pain in the big toe joint. Gout affecting the big toe is called podagra. Gout typically presents with pain, redness, hotness, and tenderness of the affected joint.

Gout also presents in acute attacks which, if occur repeatedly for a prolonged period of time, may cause damage to the joint.

Treatment of gouty arthritis includes the use of medicines that lower blood uric acid levels such as allopurinol and colchicine, anti-inflammatory medicines such as steroids injected into the joint, and analgesics including ibuprofen.

Additionally, lifestyle modifications such as weight loss, reducing intake of red meat, seafood, alcohol, and drinks high in fructose, as well as incorporating dairy products and vegetables into one’s diet are also integral in reducing the severity of symptoms and preventing recurrence of gout attacks.

Hammer/Mallet/Claw Toe

 Hammer Toe is another common cause of big toe joint pain. These conditions are characterized by abnormal alignment of the bones and joint of the toes. The toes except the big toe are made of three joints. The big toe has three joints.

  • Hammer Toe – In this condition, the middle toe joint is bent downwards such that the middle of the toe appears to arch up. The toe looks like the head of a hammer in this condition.
  • Mallet Toe – The distal toe joint of the big toe, in this condition, is bent downwards and is difficult to straighten out
  • Claw Toe – In claw toe, the middle and distal toe joints are bent downwards, giving the toe the appearance of a claw.

Each of these conditions alters the structure and function of the big toe, resulting in pain on walking, running, and in making major foot movements.

Bunions

bunion

Photo from Flickr courtesy of Badly Drawn Dad

Bunions, also called hallux valgus, are a very common cause of big toe pain.

A bunion is a large, knobby lump on the big toe caused by a malpositioning of the joints and bones of the big toe.

This malalignment gives the appearance of a knob on the big toe. This is contrary to believed thought that bunions are bony growths on the big toe.

Bunions can also be caused by musculoskeletal conditions such as rheumatoid arthritis. Bunions present with a tender, red, hard lump on the big toe.

Resolving bunions mainly involves conservative measures such as the following;

  • Prevent constant rubbing of the bunion against your footwear by placing a pad over it before you wear your shoes
  • Perform stretch exercises of your toes to improve their mobility and strength.
  • Wear wide, flat, and proper-fitting shoes. Tight-fitting shoes add more pressure to the bunions worsening the symptoms.
  • Apply ice packs over the bunion to lower the inflammation.
  • Use analgesics such as ibuprofen.

Often, conservative measures such as those outlined above lead to good resolution of the symptoms. In severe cases, however, one might need a surgical realignment of the big toe joints.

Ingrown Toenail

Ingrown Toenails Vs Normal ToenailsIngrown toenails occur when the curved edge of the nail grows into the adjoining skin.

Ingrown toenails often cause severe pain, swelling, and redness in the big toe. If it is left untreated, this may allow bacteria gain entry into the area causing infection.

Ingrown toenails are caused by poor foot hygiene, improper trimming of the toenails, toe injury, wearing ill-fitting shoes, and structural abnormalities of the toenail.

An ingrown toenail can be treated by a podiatrist and treatment often involves foot soaks, use of anti-inflammatory drugs, and separating the nail from the skin with a forceps then applying cotton balls to prevent the nails from growing back in.

Turf Toe

Turf ToeTurf toe is a very common cause of big toe joint pain.

It is a common sports-related injury of the toes caused by sprain and damage to the small ligaments of the toe joints.

This usually results from hyperextension of the big toe which may be a result of an acute injury or repeated small injuries to the ligaments.

Turf toe presents with pain in the bottom of big toe joint, stiffness, swelling, and redness in the big toe.

Treatment of turf toe includes the application of ice, elevation of the foot, and rest of the foot. In severe cases, you might require surgical intervention.

Tennis Toe

Tennis Toe NailTennis toe is caused by repetitive damage to the toenail causing blood to collect under the nail.

Activities which cause the toe to repeatedly slam the edge of a shoe such as in tennis where foot positions are changed swift are associated with tennis toe.

Tennis toe presents with throbbing pain in the big toe and reddish discolouration of the nail.

It can be treated with simple conservative measures such as rest, analgesics, and wearing proper-fitting shoes.

Toe Arthritis

Arthritis is one of the most common causes of pain in the big toe. Arthritis of the big toe most commonly affects the metatarsophalangeal joint (MTPJ) which is at the base of the big toe.

The big toe is one of the most stressed among the toes as we walk about. It glides continuously as we move the feet making it vulnerable to wear and tear.

The commonest type of arthritis affecting the big toe is osteoarthritis which is a chronic inflammatory disease of the joint cartilage. Toe osteoarthritis causes the destruction of the cartilages and osteophytes of the MTPJ causing the big toe to stiffen eventually.

Osteoarthritis of the big toe often results from structural problems of the foot and wear and tear due to overuse. Other less common types of arthritis affecting the big toe include rheumatoid arthritis, gouty arthritis, and psoriatic arthritis.

Common symptoms of toe arthritis include pain in the big toe, stiffness, swelling, and redness of the big toe.  The pain of arthritis of the toe is generally worse when walking or standing and is relieved by rest.

Treatment of arthritis of the toe is usually conservative and includes rest of the toe, ice therapy, use of analgesics such as non-steroidal anti-inflammatory drugs (NSAIDs), wearing proper-fitting footwear and shoes with stiff insoles, and physical therapy. In cases where the inflammation does not respond to conservative management, surgery may be considered.

Toe arthritis, if not treated early, causes the formation of abnormal growths called bone spurs on the toe. These growths also contribute to the symptoms and are usually treated by surgical excision.

Morton’s Neuroma

Morton’s neuroma is a condition in which the soft tissues around the nerves coursing between the toes are thickened, consequently leading to compression and irritation of the nerves.

This nerve compression may also result from foot conditions such as bunions, hammertoe and prolonged wearing of tight-fitting shoes. Morton’s neuroma most commonly affects the 3rd and 4th toe.

Symptoms of Morton’s neuroma include numbness, burning pain, and tingling in the affected toe as well as the area between the toes and the sole of the feet.

Treatment of Morton’s neuroma is conservative and consists of rest, use of shoe insoles or orthotics, analgesics and anti-inflammatory drugs, ice therapy, and physical therapy.

Sesamoiditis

Sesamoiditis is an inflammation of the sesamoid bones. These are a pair of tiny pea-shaped bones within the tendon running to the big toe. These bones ensure effective flexion of the big toe.

Sesamoiditis often occurs due to overuse, acute injury, or prolonged pressure on the ball of the foot as seen in activities such as prolonged or frequent running and in wearing high-heeled shoes.  Activities which involve balancing on the toes such as ballet dancing and basketball are also very common causes of sesamoiditis.

The symptoms of sesamoiditis include swelling and pain in the big toe, especially under the toe in the ball of the foot. Typically, the pain of sesamoiditis is of gradual onset and worsens on standing and walking.

Treatment of sesamoiditis involves reducing pressure over the big toe by wearing proper-fitting shoes, using padded shoe insoles, shoe orthotics, rest, use of analgesics, and ice therapy.

Further shoe recommendations include wearing rocker-bottom shoes or shoes with hard soles, both of which relieve pressure on the ball of the foot.

In more severe cases or in cases of sesamoid bone fracture, treatment may also involve the use of non-weight bearing assistive devices such as crutches.

 Blisters

Blister on FootFoot blisters occur commonly on the toes and often result from damage to the skin due to intense friction between the skin and footwear.

Blisters occur when one wears ill-fitting footwear or as a result of chemical and thermal burns.

Other causes of pain in the big toe include fractures, blood vessel diseases impairing blood flow to the toes, toenail problems such as onychomycosis, diabetes causing nerve damage, bone tumours, capsulitis, and blue toe syndrome.

How to Prevent Big Toe Pain

Big toe pain is a very preventable symptom and the following tips are effective at preventing and reducing the symptoms of big toe pain.

  • Proper Foot Hygiene – Ensure you wash your feet daily with mild soap and water to remove microbes. In addition, ensure you wash your socks regularly and wear only clean socks.
  • Check your feet daily – Ensure you examine your foot for cuts, sores, blisters, cracks, nail changes, or any discolouration.
  • Keep your feet moisturized – Dry, cracked feet make the feet vulnerable to infection, therefore, ensure you apply moisturizing lotions to the dry areas of your feet.
  • Inspect your footwear – Ensure your shoes are rid of any material that may irritate your feet. Also avoid poorly-fitting shoes and shoes with high heels, as these make the feet vulnerable to injuries and structural malformations. Shoes with a wide toe box and lower heels create enough space for the feet reducing the risk of foot disorders.

Additionally, you should begin wearing new shoes gradually, so as to prevent frictional problems.

  • Wear socks – Always wear socks before you wear your shoes. The socks protect your feet from frictional injuries and blisters.
  • Keep your toenails well-trimmed – This ensures microbes are not trapped in the nails and also helps prevents ingrown toenails.
  • Perform foot exercises – Stretch exercises of your foot keep them strong and flexible preventing functional injuries. Examples of foot stretch exercises include Achilles stretch, big toe stretch, and toe pull.
Big toe pain is a very common complaint and that’s not surprising because the big toes bear much of the body weight when we stand, walk, and run.

Big toe pain often results from poor foot mechanics, wearing tight-fitting shoes, blisters, bunions, fractures, overuse injuries, ingrown toenails, and nail infections.

Other symptoms associated with big toe pain include swelling, tenderness, and warmth of the ball toe or ball of the foot. It also causes difficulty walking, running, and standing.

Treatment of most of these causes of big toe pain is conservative and consists of rest, cold therapy, elevation of the foot, use of analgesics, orthotics, and physical therapy. In severe cases and cases where symptoms do not respond to conservative management, surgery may be required to cause resolution of symptoms.

Big toe pain can be prevented by maintaining proper foot and nail hygiene, foot stretch exercises, wearing proper-fitting shoes and using orthotics.

Dr. Sachin
 

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