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Ow, My Big Toe Hurts, Big Toe Pain?

Mar 23, 2023

What causes big toe pain? What causes big toe pain and swelling and what causes pain in big toe joint? Pain in big toe when walking? Pain in big toe when bending back?

There are many thing that can cause big toe pain.

Some causes of pain in the big toe and joint are:

Bunions

This is a hard bony lump near the big toe joint also also known as ‘hallux valgus. This is a deformity of the big toe joint in which the big toe excessively angles towards the second toe and leads to a bony lump on the side of the foot. Irritation from footwear or other factors a sac of fluid can also form as the body protects itself, known as a bursa which can become inflamed, red and sore known as bursitis.

Arthritis

Arthritis is inflammation of one or more of your joints. It can cause pain and stiffness in any joint in the body and is common in the small joints of the foot and ankle. There are 2 types of arthritis osteoarthritis and rheumatoid arthritis. Osteoarthritis is ‘wear and tear’ of the joints also known as a degenerative joint disorder. It is the most common form of arthritis which can occur in any joint in the body. Rheumatoid arthritis is an autoimmune disorder and inflammatory disorder. The body’s immune system targets and attacks healthy cells in the body leaving the affected joints painful and swollen (inflammation) with tissue damage/loss.

Stubbed toe, Broken toe, Injury

A stubbed toe can lead to a broken or fractured a joint or toe leading to pain. Trauma can involve soft tissue damage around the joint in the ligaments and soft tissue of the foot. This can lead to pain, swelling, redness or bruised toe and it causes pain and hurts when moved or with activity. Broken toes are very common and caused by either something falling on the toe or being crushed or a stubbing of the toe with any foreign object. The GP should be contact if in any doubt regarding a broken toe or pain and or urgent care as soon as possible. X-rays may be taken to determine if it’s a fracture or a bad bruise which can be advised by the GP or urged care team. Fractures or breaks of the toes are common occurrences which occur when an individual kicks an hard object, drops a heavy object on the toe or repeatedly stressing a joint by repeating a movement that puts pressure on the toe leading to fractures.

Toe trauma such as bruising or known as Toe Contusion

It is the damage of the blood vessels (veins and capillaries) that return blood from your tissues back to the heart. The blood pools there and turns blue or purple. It’s typically caused by a bump, hit, or fall. You can safely treat this at home with rest (no exercise), ice, compression (via tape or a wrap), and elevation by putting your feet up. Over-the-counter pain medications can also be used if the pain is really bothering you but always seek medical advise.

Gout

Sharp, sudden pain in the big toe joint that strikes when you least expect it—sometimes even in the middle of the night—is one of the hallmark symptoms of gout. Often the pain and hypersensitivity can be so intense that even putting a sheet on top of your toe can hurt. Gout is actually a metabolic condition that stems from the body’s inability to efficiently purge uric acid from the bloodstream. When uric acid levels get too high, it can start forming sharp crystals that deposit painfully in the tissues surrounding a joint. (Although any joint can technically be affected, the big toe is by far the most common.)

Turf Toe

It is a common injury in sports such as football and rugby. However, it’s possible to develop turf toe from any sport or physical activity—running and dancing. It is a sprain of one or more of the ligaments that support the joint at the base of the big toe. It is the result of hyperextending your toe past its intended range of motion. Some common signs are pain, swelling, and limited joint movement.

Raynauds

Raynards can cause nerve pain in the big tie joint. When we are exposed to the cold, a normal response of the body is for the blood vessels, such as those in the fingers and toes, to become narrower. When someone has Raynaud’s, the narrowing of the blood vessels is more extreme, resulting in the skin changing colour. The fingers and toes may change from white to blue, and then to red. A Raynaud’s attack can be very painful, especially as the circulation returns. Raynaud’s can also affect the lips, nose, ears and nipples in the same way. Raynaud’s attack are triggered with exposure to the cold and emotional stress. Most people diagnosed with the condition will have primary Raynaud’s, meaning that there are no other complications. Secondary Raynaud’s is far less common, and is caused by another autoimmune condition, such as scleroderma. It is often the first sign that people notice. Someone who has secondary Raynaud’s may be prone to more serious complications as a result of Raynaud’s attacks, such as finger ulcers.

Chilblains

A chilblain is a condition which results from defective blood circulation on exposure to cold. The skin may first become itchy, then red and swollen with a burning sensation and very tender to touch. An infection may occur should the skin break down. Chilblains usually appear on the extremities fingers, toes and ears. Dampness and cold winds when temperatures are around freezing, can cause damage to unprotected skin. The elderly and very young are most vulnerable. Chilblains usually go away over 7-14 day. The tiny blood vessels under the skin narrow (constrict) when the skin becomes cold and the blood supply to areas of skin may then become very slow. As the skin re-warms there is some leakage of fluid from the blood vessels into the tissues which in some way causes areas of inflammation and swelling leading to chilblains.

Symptoms include: Pain, tingling and numbness when you’re cold or stressed, toe/toes can change colour

Sesamoiditis

Sesamoids are bones found within tendons in the big toes. They often are found where tendons pass over joints. The sesamoid bones under the big toe can become painful they have fractured, or had trauma causing inflammation and the blood supply can be damaged and they can fragment, and due to arthritis with the metatarsal and a bursa (fluid filled sac) under the sesamoids can become inflamed and swollen.

Ingrown toe nail

Ingrown toenails are a common condition in which the corner or side of a toenail grows into the soft flesh. The result is pain, inflamed skin, swelling and, sometimes, an infection. Ingrown toenails usually affect the big toe.

Arthritis of the big toe. (Hallux Limitus or Rigidus)

The big toe joint is the most common site for osteoarthritis in the foot. This can occur from late teens onwards, though it is more common with increased aged. It is thought to affect about 20% of people over the age of forty. ‘Hallux’ is the medical term for the big toe. ‘Limitus’ means there is reduced movement at the big toe joint which is an indication of osteoarthritis. Hallux rigidus means the joint will no longer move and is locked in place with no movement. Full motion (dorsiflexion) at the big toe joint is normally 90°. Recent studies have shown that the joint does not requires more than 45° of movement at the big toe joint during normal walking. Osteoarthritic changes can be quite moderate by the time the patient starts experiencing some level of pain and swelling that requires them to seek medical attention.

What causes osteoarthritis of the big toe?

In most cases, these changes are due to a specific injury or repetitive minor trauma. Certain recreational and occupational activities can lead to degenerative changes over time. The chances of developing osteoarthritis in the big toe are increased if you have a flat arched (pronated) foot, if you already have a bunion, if there is a family history of osteoarthritis in the big toe or other joints and with wearing shoes that are too flexible or if the heel is too high putting pressure on the joint itself. There are some conditions such as rheumatoid arthritis and gout that can lead to changes within the joint which results in degeneration and subsequent osteoarthritic changes. These conditions normally affect more than one joint. Other rare causes of big toe joint pain include infection or a piece of bone within the joint space.

How is osteoarthritis of the big toe diagnosed?

These osteoarthritic changes have quite a characteristic appearance. The joint will normally be enlarge. There can be a bony lump ‘Osteophyte’ over the top or the side of the big toe joint. Pain can typically be experienced by bending the big toe joint upwards with your hand, most commonly at the end of this range of motion.

These signs and symptoms will normally be sufficient for the clinician to make the diagnosis. Sometimes investigations such as x-ray may be used to help decide the best way to treat the condition. Blood tests may be ordered if there are any reasons to suggest that the symptoms may be due to connective tissue or auto immune conditions such as gout, and rheumatoid arthritis.

Hallux valgus

The term Hallux Valgus, is commonly referred to as a bunion. It is a complex valgus deformity of the first ray that can cause medial big toe pain and difficulty with shoe wear. Diagnosis is made clinically with presence of a hallux that rests in a valgus and pronated position. A bunion is a deformity of the joint at the base of the big toe. The joint protrudes outward and creates a visible bump on the side of the foot. This abnormality causes the toe to point in the opposite direction and potentially overlap onto the toe next to it. Shoes can lead to pressure on the protruding joint, and, over time, the pressure may cause a fluid filled sac in the joint known as a bursa, to swell and become inflamed. This is a result of the bodies protective mechanism of the joint itself by protecting it by forming a bursa. Radiographs can be obtained of the foot to identify the severity of the disease and surgery in severe situations. Treatment can be nonoperative with shoe modifications for mild and minimally symptomatic cases. Surgical management is indicated for progressive deformity and difficulty with shoe wear.

Will the pain get worse?

Arthritis is a progressive condition and typically will get worse through time though this is usually very gradual over a number of years. As a result, the joint will become more stiff and prominent / enlarged. Although the degree of pain is generally related to the extent of arthritic change, it does not necessarily get more painful through time. The joint can continue to stiffen until the point that it stops moving altogether. Often, at this stage, there can be a reduction in pain.

It is common for people to experience other symptoms away from the big toe joint due to changes in the way that they walk to compensate for the loss of big toe joint movement. There can be discomfort over the outside of the foot as you ‘push off’ away from the big toe joint. Pain over the outside of the ankle and lower back pain can also occur.

How to stop big toe pain and how to heal big toe pain.

  • Exercises
  • Orthoses (special devices inserted into shoes)
  • Shoe alterations or night splints which hold toes straight during sleep (helps to slow the progression of bunions in children)

These are all conservative measures and, although they may help relieve symptoms, there is no evidence they can correct the underlying deformity. The podiatrist may enable to identify any significant deformity/ structural or mechanical defect in structure and refer for surgery, which can involve a combination of removing, realigning and pinning of the bone. With a bunion, surgery can realign the toe joint in a common procedure known as a bunionectomy or osteotomy.

Arthritic toe pain – what can I do to self help? Will I require any treatment?

Usually the symptoms associated with big toe pain can be self-managed, but below are other treatments which can be used in such condition such as arthritis:

Pain relief

You can take simple pain killers if the pain is significant and interfering with your daily activities. Try paracetamol first as side-effects are rare if you stick to the correct dosage. Sometimes anti-inflammatory medicines such as ibuprofen are useful. If you have never taken this type of medication before, or have not done so for a long time, you should first check with a pharmacist, or your GP to make sure there is no reason why you should not take these. These are painkillers but they also reduce inflammation and may work more effectively than ordinary painkillers. Some people find that rubbing a cream or gel that contains an anti-inflammatory medication, onto the joint can also be helpful.

Ice

This can help to reduce the pain and inflammation associated with the condition. This can be very effective at the end of a busy day. Place some ice cubes or a bag of frozen peas in a tea towel. Place on the joint for 10-15 minutes. This can be repeated on the same day though not within 2 hours of the last application.

Footwear

Rather than treating the symptoms, it is better to try and prevent this happening in the first place. The pain and inflammation occurs in the big toe joint because the joint is being forced to bend when your foot pushes off from the ground when walking and running. Footwear such as high heels, or footwear that is overly flexible, increase this demand on the big toe joint to bend and will lead to pain and inflammation.

It is generally found that the best type of footwear are those that are hard to bend or even completely stiff at the front of the shoe. The front of the shoe should also have a roll or a rocker. These properties in a shoe will act to splint the joint and reduce the demands on the joint to bend. Shoes may also need to be quite deep at the front of the shoe to accommodate the enlarged joint. Many people find that they can control the pain well if they wear this type of footwear most of the time.

Foot orthoses

This intervention can offer benefit though it is likely to only be considered at an early stage, with the aim of improving the motion at the big toe joint during walking/sporting activities. This is unlike to help much in the more advanced stages where the joint is quite stiff.

Steroid injections

A steroid (cortisone) injection, which usually includes a local anaesthetic, can sometimes be used. As with any osteoarthritic condition, there are, however, no guarantees on how long any benefit will last. The symptoms may recur quite soon, within days or weeks, although there might not be a recurrence of pain for over a year. Adherence to footwear advice should prolong any benefit experienced from a steroid injection. It is not advisable to have too many steroid injections to the same joint, over a short period of time, as there are concerns that this may accelerate further osteoarthritic change.

Surgery

A referral can be made for you to be assessed in a surgical department where it can be decided if it is appropriate for you to have an operation. In some cases people may benefit from having surgery for this condition, however, as with all operations, there are risks and complications that can occur and these will be discussed with you by your specialist. It is also important to be aware that, following surgery, you may be left with some pain and stiffness and the deformity can recur again in the future. It is therefore not advisable to have surgery if the deformity is not painful and does not limit your daily activities.

What causes pain in big toe nail?

Ingrown toenails are a common condition in which the corner or side of a toenail grows into the soft flesh. This results in pain, inflammation around the skin/nail, swelling and, can lead to an infection. Ingrown toenails usually affect the big toe.

Often you can take care of ingrown toenails on your own. If the pain is severe or spreading, your health care provider can take steps to relieve your discomfort and help you avoid complications of ingrown toenails. Wearing ill-fitting or tight shoes can aggravate or cause an ingrown toenail. There is a greater risk of complications of ignoring toe nail with Diabetes or conditions with poor blood flow to your feet/lower limb.

Can sciatica cause big toe pain?

Sciatic pain can radiate down into the big toe, due to herniation of the disk in the L4 or L5 level of the lower back and has pinched the sciatic nerve. This pain can be accompanied by a numbness or tingling sensation along the top of the foot and into the big toe. It may also cause something known as foot drop. Food drop is marked by difficulty lifting the front part of the foot. This can change the gate of your stride, causing you to drag the affected foot as you walk. Like sciatica, this isn’t a medical condition, but rather a symptom of an underlying disorder. Treating the cause of the sciatica should treat foot drop. However, in some situations patient may have underlying neurological conditions such as MS and can also lead to foot drop and phantom foot pain.

What nerve causes big toe pain?

Raynards can cause nerve pain in the big tie joint. When we are exposed to the cold, a normal response of the body is for the blood vessels, such as those in the fingers and toes, to become narrower. When someone has Raynaud’s, the narrowing of the blood vessels is more extreme, resulting in the skin changing colour. The fingers and toes may change from white to blue, and then to red. A Raynaud’s attack can be very painful, especially as the circulation returns. Raynaud’s can also affect the lips, nose, ears and nipples in the same way. Raynaud’s attack are triggered with exposure to the cold and emotional stress. Most people diagnosed with the condition will have primary Raynaud’s, meaning that there are no other complications. Secondary Raynaud’s is far less common, and is caused by another autoimmune condition, such as scleroderma. It is often the first sign that people notice. Someone who has secondary Raynaud’s may be prone to more serious complications as a result of Raynaud’s attacks, such as finger ulcers.

Raynaud’s phenomenon is also known as Secondary Raynaud syndrome. This is a condition that causes small arteries in the skin to abnormally constrict on exposure to cold water or air. This limits blood flow to the hands, fingers, feet, toes. Secondary Raynaud syndrome is rare and caused by underlying medical conditions, often a connective tissue disorder such as rheumatoid arthritis, scleroderma, or lupus. Symptoms include the hands and feet becoming numb and cold, skin colour changing from pale to bluish, to red as the skin warms again. Without treatment it can lead to ulcerations and sores or deformities of the fingers and toes, or lead to gangrene, due to the lack of circulation.

Big toe pain near nail, near cuticle, under nail?

Paronychia is an infection of the skin of the fingers or toes, at the place where the skin folds down to meet the nail. Acute, or sudden onset, paronychia is caused by the staphylococcus bacteria. The organism can gain entry if the nail is cracked, broken, bitten, or trimmed too closely. Chronic, or ongoing, paronychia is caused by a fungus. Anyone whose work requires their hands to be wet much of the time is susceptible. People with diabetes or a weakened immune system are more susceptible to nail infections. Some symptoms may include sore/tender skin, pain, redness, inflammation or swollen skin around the nail and exudate such as pus collecting under the skin.

Big toe pain and cracking, stiffness, numbness or burning electric shock feeling in big toe

There are different types of causes for electric shock feeling. This is mostly due to some neurological or nerve pain or impingement. Some conditions that may cause this are:

Baxter’s neuropathy

Baxter’s neuropathy is a form of nerve entrapment. It results from the compression of the inferior calcaneal nerve, which sits just under the base of the foot’s arch. Risk factors include: plantar fasciitis which is an inflammation of the plantar fascia, the part of the feet that connects the heel bone to the toes, obesity, bone spurs and flat feet or fallen arches.

Morton’s neuroma

Morton’s neuroma involves thickened tissues compressing nerves between the toes. Pain may be experienced on the bottom of the foot which worsens when walking, particularly in tight high heels. The pain may fade during rest or after removing the shoes. The pain may be burning, stabbing, or tingling, or it may feel like an electric shock. It may extend to the back of the foot or leg, causing cramping. Some people also experience numbness between their toes. Some common causes of Morton’s neuroma are wearing narrow shoes or wearing high heels, inflammation of the joints, thickening of foot ligaments, injury to the front of the feet, such as from high-impact sports or jogging and lipomas which are lumps beneath the skin that contain an overgrowth of fat cells.

Tarsal tunnel syndrome

Tarsal tunnel syndrome causes pain in the feet and legs due to compression of the posterior tibial nerve, which runs down the back of the lower leg, or the plantar nerves in the feet. The condition appears to be more common in females and symptoms of tarsal tunnel syndrome may include sharp, shooting pain in the inner ankle and along the foot, numbness on the underside of the foo, pain when flexing and moving the foot and tingling or burning sensation in the feet. These symptoms may worsen at night, while walking or standing, or after physical activity and the pain can often decrease after resting. Tarsal tunnel syndrome may result from wearing poorly fitting shoes, injuring the feet or legs, varicose veins or ganglion cysts.

Peripheral neuropathy

Peripheral neuropathy is an umbrella term for numbness, tingling, and burning sensations in the toes, feet, fingers, hands, or a combination of these areas. The symptoms may worsen at night. Peripheral neuropathy can cause nonspecific symptoms that make it difficult to move the feet and do basic activities. There are increased chances of  developing peripheral neuropathy due to infections, a deficiency of a nutrient, such as B12, alcohol use disorder, diabetes mellitus, due to certain hereditary conditions, such as Charcot-Marie-Tooth disease, which causes a loss of muscle tissue or MS or Guillian-Barré syndrome, a condition which causes rapid muscle weakness.

Diabetic neuropathy

Both type 1 and type 2 diabetes mellitus may cause nerve pain in the toes and feet. Diabetic neuropathy affects more than 90% of people with diabetes. The nerve pain first affects the toes and surrounding areas, and it may then slowly spread to the rest of the feet and up the legs. Symptoms of diabetes mellitus may include tingling, burning, sharp, or shooting pain in the toes or feet, the sensation of an electric shock in these areas, pain that usually worsens at night, causing sleep disturbances and pain when touching the skin. There are several factors which may increase the chances of people with diabetes developing neuropathy due to advancing age, having had diabetes for a longer period, due to the consumption of alcohol and due to the use of tobacco.

Sciatica

Sciatica occurs when something damages or compresses the sciatic nerve. This is the longest and widest nerve in the body, which extends from the lower back, through the buttocks, and down the legs, ending just beneath the knee. The most common cause of sciatica is a herniated, or bulging, disk in the spine. Although sciatica tends to affect the back, hips, and upper legs first, the pain can spread down the legs into the feet and toes. Some symptoms of sciatica may include back pain on one side, pain or a burning sensation in the buttocks, leg weakness or muscle weakness and pain in the leg and foot.