• Dr. Jennifer Nicole Falk

Such a Pain in the Big Toe

Updated: Aug 13, 2018



Who knew that one small joint in the foot could cause so much pain? The big toe joint is just one of the 33 joints in the foot, but it is an important one (1). There are 7 ligaments that surround the joint to help stabilize it and multiple tendons that cross the joint to help flex or extend the big toe (2). The joint withstands significant forces while walking and should have at least 65 degrees of dorsiflexion (bending upwards motion) during propulsion for normal walking pattern. When the joint and/or surrounding area gets injured, though, pathology, pain, and deformities can result.

Check out my list below for some of the more common conditions that can cause pain in and around the big toe joint. Of note, this list provides information about the different pathologies that involve the big toe and big toe joint. It is not a complete list and does not go over treatment options. Because there are many pathologies involving the big toe joint, it is important to see a healthcare professional to correctly diagnosis the correct condition and further discuss the appropriate treatment options for you.


TURF TOE

Turf toe is a term used for hyperextension (upwards bend too far) injuries of the big toe joint that result in a sprain in the ligament underneath. It is common amongst athletes, especially those who play on hard artificial surfaces with flexible shoes (3).

Swelling, pain, and instability may be present around the big toe joint. A thorough examination by a healthcare professional should be performed to rule out other injuries around the joint, including a fracture or injury to a nearby tendon or muscle (3).


BUNION

A bunion develops when the first metatarsal bone moves away from the smaller metatarsal bones and the big toe moves towards the second toe, thus creating a bump around the big toe joint. The bony bump that is seen along the inside of the foot is actually the head of the 1st metatarsal bone. Bunions may develop for a variety of reasons, but oftentimes there is a genetic component to it, meaning the foot type you inherited from your parent(s) predisposes you to developing the bunion. Based on your foot type and the way in which you walk (aka the pathomechanics), certain tendons pull and gain mechanical advantage over other tendons, causing instability of joints and foot deformities, including the bunion. Injuries, neuromuscular conditions, and shoe gear (or the lack thereof) can also contribute to the onset and/or progression of the bunion deformity.

The pain associated with bunions is usually around the area of the bump and occurs when the area is irritated (e.g. rubbing inside tight shoes).


SESMOIDITIS AND SESAMOID FRACTURE

The sesamoid bones are two small bones underneath the 1st metatarsal head. In people with higher arches, and during high impact activities, these bones are put under increased stress. Too much stress on them can cause them to become inflamed or even break.

The pain is usually pinpoint to the individual sesamoid bone and is present with standing, walking, or other higher impact activities that put increased pressure on the bone(s). The pain is usually improved with rest or offloading of the bone.

ARTHRITIS OF THE BIG TOE JOINT


(AKA HALLUX LIMITUS OR HALLUX RIGIDUS)

Hallux limitus, or rigidus, is the loss of motion of the big toe joint. It is a progressive disorder, in which there is degeneration and loss of cartilage of the joint, causing stiffness and pain. The limited motion and arthritis of the joint can be a result of several factors, including foot structure and the associated pathomechanics, excessive repetitive microtrauma (common in sports), acute trauma or injuries, and other inflammatory conditions (e.g. gout).

The pain may be present with first steps after periods of rest, when trying to squat, or while wearing high heeled shoes.


GOUT

Gout is a specific type of arthritis that is the result of uric acid build-up in joints. There are three main causes of uric acid build-up in the body: #1) the body producing too much uric acid; #2) the kidneys cannot excrete the uric acid; #3) consumption of too much purines (click here to see the “Gout Diet: Dos & Don’ts”) (4).

In the foot, the big toe is the most commonly affected joint. Acute gouty attacks can cause increased redness, swelling, and severe pain in the joint. Because gout can present similar to an infection, it is important to be worked up by a healthcare professional.


INFECTION

Infection of the joint is rare, but can occur, especially if there is an open wound or sore around the area.

Like gout, the area may be red, warm, swollen, and painful; however, there may be additional abnormal drainage (e.g. yellow). If the infection gets into your bloodstream, it can also make you feel ill (i.e. nauseated, vomiting, fevers, chills). Therefore, it is crucial to seek help immediately if you feel you may have a joint infection.

DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.

References:

1. Anatomy of the Foot and Ankle. (1999). Retrieved from http://www.healthcommunities.com/foot-anatomy/foot-anatomy-overview.shtml

2. Sheinberg, R.H. Injuries to the Big Toe Joint. Retrieved from http://www.southfloridasportsmedicine.com/injuries-to-the-big-toe-joint.html

3. VanPelt, M. D., Saxena, A., & Allen, M. A. (2013). Turf toe injuries. In Sports medicine and arthroscopic surgery of the foot and ankle(pp. 13-28). Springer London.

4. What Is Gout? (2014, November). Retrieved from https://www.niams.nih.gov/health_info/gout/gout_ff.asp


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