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Big Toe Pain

Dr. Sara Karamloo

Reviewed by
Dr. Sara Karamloo

Our feet are complex structures comprising numerous bones, joints, muscles, tendons, and ligaments. As the primary structure necessary for push-off during normal gait, the hallux, or big toe, takes the brunt of our daily activities. This means that it is the last part of the foot to leave the ground with each step. Hallux pain can sometimes extend from deep inside the joint; at other times it is localized to the nail. Whatever the cause, hallux pain makes it difficult for many people to remain active.

There are various causes for hallux pain. The cause is often an underlying condition, such as gout, or a fracture resulting from trauma. Other times the culprit may be something less obvious, such as an underlying structural deformity, disease, or vascular issue. Hallux pain, regardless of its origin, can become extremely bothersome for those who need to walk or stand for long periods. Delays in treatment can sometimes lead to morbidity, possibly requiring amputation.

big toe pain

Big Toe Pain Symptoms

Hallux pain can be the result of an underlying problem. Other symptoms that sometimes accompany hallux pain include:

  • swelling
  • redness or discoloration
  • drainage
  • cold digit
  • pain after rest
  • pain with ambulation
  • difficulty with footwear
  • stiffness in the joints
  • bruising

The underlying cause may be important. If swelling and bruising accompany the pain, there is a good chance that an injury has occurred, especially if the pain came on suddenly and was associated with trauma. If there is sudden discoloration or a cold digit, then there may be a more serious underlying cause—possibly a distally lodged blood clot that could have come from the heart, or blockage of the arteries causing ischemia (restriction of blood supply to the tissues) and necrosis of the digit. Nail pain accompanied by obvious drainage, redness, and swelling may indicate an ingrown toenail that has become infected. Sudden pain and redness localized to the first metatarsal phalangeal joint (i.e., the tip of your toe) may be a result of increased uric acid levels, meaning a gout attack. Joint pain may be caused by underlying osteo-arthritis or by a more serious condition such as a bone tumor. Unless you have a clear-cut explanation for your pain, it is best to have your pain diagnosed by a foot and ankle specialist before the condition worsens.

Big Toe Pain Causes

Because pain in the big toe is a symptom, there could be numerous reasons for it. Common causes of big toe pain include:

  • Gout
  • Vascular disease
  • Bone tumor
  • Structural deformity in toe
  • Inflammation of the tendons and ligaments surrounding the hallux
  • Obvious injury
  • Ingrown toenail
  • Fracture
  • Bunion
  • Osteoarthritis
  • Rheumatoid or other seronegative arthritides

If you have already been diagnosed with one of these conditions, you have probably been told that hallux pain is a common symptom, especially with gout, bunions, and hallux rigidus. However, if you have never been diagnosed with any of these conditions, have not been injured, and have never had previous symptoms, you should seek medical attention immediately. Treating the underlying cause can usually relieve big toe pain.

When to See Your Doctor

If you are experiencing pain in your big toe and have no existing medical conditions, you should consider seeking medical attention from a foot and ankle specialist. In almost all cases, diagnosing and treating an underlying condition or injury in its early stages can reduce your chances of progression leading to surgical intervention. Furthermore, many of the above conditions can only be diagnosed with additional imaging, blood tests, cultures, biopsies, or urine analyses. Anytime you experience symptoms from the list above, or if you have concerns, you should see your doctor.

Diagnosing Big Toe Pain

When you first meet with your physician, he or she will ask you questions about your symptoms, your activities, and your medical history. These questions will help him or her diagnose you correctly. You will be given a physical examination, and you may be required to submit a blood sample for testing to rule out conditions such as gout or an infection. You may also be given an x-ray or additional imaging tests (MRIs, CT scans) to help your doctor rule out a broken toe or damage to the surrounding tissues. Once a proper diagnosis is made, treatment can begin.

Treating Big Toe Pain

Treatment for your pain will depend heavily on the cause and severity of the pain. Over-the-counter pain medications such as ibuprofen can reduce inflammation and mild pain. You may also benefit from wider shoes, orthotics such as inserts or padding, or the RICE method. RICE stands for Rest, Ice, Compression and Elevation, and it is commonly used by athletes to relieve pain. For moderate to severe pain, non-surgical methods available include:

  • Prescription-strength anti-inflammatory medication
  • Stretching exercises performed routinely
  • Prescription pain medication
  • Corticosteroid injections
  • Physical therapy

Your doctor’s recommendation will depend on the cause of your big toe pain. For example, if you suffer from gout you may need to make dietary changes or be placed on gout medication. If you have a bunion, you may need surgical intervention for correction. If you are suffering from poor circulation, you may need to follow up with a vascular specialist. If you have an infected ingrown toenail, you will need to be placed on antibiotics and have the nail border removed. Again, the appropriate treatment will be prescribed by a doctor based on the cause of the problem.

Preventing Big Toe Pain

Here are some tips to help you prevent big toe pain from occurring or recurring:

  • Wear shoes that fit you properly; offer support, balance, and stability; and have wide toe boxes.
  • Exercise your feet, ankles, and lower legs on a regular basis to keep your muscles strong.
  • Seek nutritional advice if you suffer from gout.
  • Drink plenty of fluids, especially during athletic activities.
  • See a podiatrist on a regular basis, especially if you have diabetes or spend a lot of time on your feet.
  • See a podiatrist at the first sign of symptoms.

Talking to Your Doctor

Here are some questions you may want to ask your doctor about pain you are experiencing in your big toe:

  • What type of diagnostic tests will we need to do to determine what is causing my big toe pain?
  • What can I do to reduce the pain in my big toe?
  • Which over-the-counter products do you recommend for me to relieve the pain? If these products do not work, how long should I wait to contact you and reschedule an appointment?
  • What should I do if my job requires me to stand or walk for long periods?
  • How much should I limit my normal activities?
  • Since there is pain in my right big toe, should I be driving? (if applicable)
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Medical References:

  1. American Medical Association "Family Medical Guide" 4th Edition (John Wiley & Sons, Inc. 2004) 988
  2. H. Winter Griffith, MD "Complete Guide to Symptoms, Illness & Surgery" (The Berkeley Publishing Group, 2006) 340
  3. M. Beers "Merck Manual of Medical Information" 2nd home edition (Pocket Books, 2003) 404

This page was last updated on April 27th, 2014



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