Big Toe Pain?
Why is My Big Toe Hurting?
Mild discomfort in the big toe may be easy enough to shrug off for a while but if it persists, or gets worse, big toe pain cannot be ignored. If you have been experiencing pain in your big toe you may be wondering what the cause might be and how you can improve your symptoms. Well read on, sufferers of big toe pain, and we will explore some of the underlying causes of big toe pain and when to seek care from a physical therapist or doctor.
WHAT’S THE BIG DEAL WITH THE BIG TOE?
Turns out the big toe really is a big deal. The big toe, also known as the hallux, is made up of two smaller phalanx bones. You may be interested to know that each of the other four toes actually has three phalanx bones. Between the two phalanx bones lies the interphalangeal joint that allows bending of the middle of the big toe. Just behind that is another important joint called the metatarsophalangeal (MTP) joint that connects the proximal phalanx bone of the big toe to the first long bone of the foot. This joint allows the big toe to flex and extend as you walk.
If you’ve ever injured your big toe you will immediately recognize how your walking or running gait changes as you try to minimize pressure through the big toe. This is because the big toe plays an important role in propulsion of the body forward and in shock absorption as the foot hits the ground and travels underneath the body. Somewhere between 40-60% of your bodyweight is translated through the first MTP joint which means the bones, joints, tendons, and ligaments of the big toe need to be very resilient. In order to walk normally without some degree of compensation, your big toe must be able to extend (bend backwards) 45 to 60 degrees as you push off your foot to initiate a step forward. On the bottom of the foot, just behind the big toe lie two small pea-shaped sesamoid bones that act as a pulley system for tendons and as a lever when the toe pushes off.
Because the big toe has a lot of work to do each time you take a step, stand on your tiptoes, or jump up to shoot a free throw, even small changes in the strength, flexibility, and integrity of any part of the big toe can change the way you move. Now that we better understand the anatomy and function of the big toe, let’s look at some common causes of big toe pain.
WHY DOES MY BIG TOE HURT?
Big toe pain can have a number of causes. Understanding the cause of your toe pain will help guide you toward appropriate solutions.
Turf Toe: Turf toe is the common name for a sprain of the MTP joint of the first toe. This is often a sports-related injury that occurs when the toe is hyperextended past its normal range of motion. Pain around the big toe may be constant or only noticed when you press on it or try to put weight on it. The joint may feel stiff and range of motion may be limited. Alternatively the joint may feel like it is popping out of place. Finally, swelling or bruising around the big toe that extends up into the foot may occur. Injury to the ligaments and soft tissue around the MTP joint is typically the cause of the symptoms. In rare cases surgery may be required to treat severe turf toe.
Gout: Gout is a complex form of arthritis characterized by sudden, severe bouts of joint swelling, pain, warmth, redness, and tenderness. Accumulation of needle-like urate crystals in the joint causes the inflammation and pain characteristic of gout. It can occur at any joint in the body but most often occurs in the big toe. An attack of gout typically occurs suddenly. You may wake in the middle of the night with pain, heat, and redness in a joint so severe that even the bedsheet touching the area is unbearable. Untreated gout can lead to joint erosion and prolonged pain.
Sesamoiditis: Inflammation of the tendons that travel along the bottom of the foot can cause inflammation of the sesamoid bones behind the big toe. Because the big toe is a primary shock absorber for the foot, these bones are subject to repeated forces that can trigger inflammation. Running, dancing, and walking in high heels may trigger this condition.
Osteoarthritis or Hallux Rigidus: Osteoarthritis of the big toe is often called Hallux Rigidus. Degradation of the cartilage lining the joint surfaces in the big toe can cause progressive stiffening and pain with pushing off of the toe.
Bunion: A bunion (hallux valgus) is a bony bump that develops on the inside of the foot at the base of the big toe. Oftentimes the big toe is no longer straight but instead deviates toward the other toes. Inflammation and swelling can occur in the area of the bunion and that area of the foot can become stiff and painful. Discomfort during walking or running and difficulty with the fit of shoes can occur over time.
HOW DO I KNOW IF I NEED TO SEE A DOCTOR OR PHYSICAL THERAPIST?
Depending on where you live and the type of insurance you have, you may be required to see your physician and obtain a referral before seeing a physical therapist. In some states you can seek primary care from a physical therapist directly. Physical therapists are able to screen for the underlying causes of big toe pain but may refer you back to your doctor if they feel your injury requires imaging or further assessment before initiating treatment. If you are experiencing big toe pain and unsure if you need to seek the care of a medical professional these guidelines may help you decide:
The toe is red and warm: Redness and warmth typically indicate an inflammatory process that needs medical attention. Infection and gout are two possible causes of redness and warmth in the big toe. These conditions need to be assessed by a physician or podiatrist because antibiotics or other medication may be necessary.
Pain is severe and you are unable to put pressure through the toe: if you are experiencing severe pain that prevents you from bearing any weight through your big toe you should not ignore these symptoms. If you are able to recall a traumatic event such as dropping something on your toe or stubbing your toe you may be dealing with a fracture of the phalanges or first metatarsal. If the symptoms occur suddenly for instance after hyperextending the big toe, or are accompanied by visible bruising and swelling you should be evaluated by a medical professional and imaging may be required to assess the extent of the injury
Pain occurs with activity and eases with rest: In the absence of bruising, severe pain, and inability to put pressure on the big toe, pain that worsens when you are active but eases once you rest may indicate a more chronic condition. Sesamoiditis, osteoarthritis, and bunions are conditions that may present this way. If you choose to see a physical therapist first they can help determine if a trip to a physician is needed.
No matter how it started, if big toe pain is interfering with your ability to walk, run, and do your daily activities it is time to investigate the cause. Physical therapy can be very helpful in alleviating the symptoms of big toe pain for many of these conditions and the physical therapists at Evolve can help you better understand the origin of your symptoms, create a program to treat them, and help prevent their recurrence in the future
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About EvolveNY-
Brooklyn's Premier Holistic Physical Therapy Clinics- There’s physical therapy, there’s training, and then there’s EVOLVE. We use the science of biomechanics merged with fitness to help our patients get better and stay better!
First we evaluate, then we heal, then we strengthen our clients so they can reach their goals, feel better, and live happier lives. We do so by utilizing a range of core techniques and specialized treatments to reduce pain, improve mobility, enhance physical strength and deal with the underlying issues, not just the pain itself.
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