BIG TOE PAIN
Even though the joints of the toes are small, they are very important for foot functioning and overall mobility. They bear all of you body weight amplified many times over and over with each step. The big toe joint is medically know as the first metatarsophalangeal joint (1st MTPJ). This is the joint that connects the big toe to the first metatarsal bone of the forefoot. Proper functioning of this joint is paramount to overall mobility.
Some of the most common problems that most occur at this joint include:
The sesamoid bones are two small bones that sit below the big toe joint, embedded within a tendon. The sesamoid bones can be subject to pain and inflammation from acute or chronic trauma. Occasionally significant physical stress can cause fracture of these tiny bones. Sesamoiditis is often linked to activities that involve balancing on toes or jumping, such as ballet, volleyball, or basketball.
Gout is a metabolic condition associated with excess uric acid in the bloodstream that can affect the big toe joint. When uric acid forms crystals can deposit into joints—such as the big toe joint—an attack of acute gouty arthritis can occur. Symptoms of gouty arthritis include a red, hot, and intensely painful joint. It is very sore to walk on and can last hours to days at a time. If gout attacks go untreated and occur repeatedly for a number of years, joint damage may occur. Medications in combination with a healthy diet can help to control gout.
Hallux limitus is a condition that limits joint range of motion at the big toe joint. In order for the feet to efficiently distribute pressure as we walk, a certain degree of flexibility is needed at the big toe joint. When the big toe joint locks up during gait, arthritis can develop in that joint, further limiting range of motion. Hallux rigidus is used to describe when the big toe joint becomes very stiff overall, and significantly is limited in motion during normal walking.
Hallux limitus may result in a bunion, or a bump on the top side of big toe joint. Typically hallux limitus makes it painful to walk with every step, and people often try to "alter their step" to take pressure off of the big toe joint, but this often results in extra stress, pain and inflammation to other areas of the foot.
The most common form of arthritis that affects the big toe joint is osteoarthritis, caused by wear-and-tear—with typical symptoms of joint pain and stiffness. Osteoarthritis at the big toe joint may be caused by problems with foot structure and functioning (such as hallux limitus), resulting in excess wear-and-tear. Trauma such as a fracture or dislocation of the big toe can also result in osteoarthritis. Other, less common types of arthritis that affect the big toe include rheumatoid arthritis and psoriatic arthritis.
A bunion describes a large bump over the big toe joint that is associated with a common foot condition known as hallux valgus. Besides the appearance of a bump, bunions cause a shift in position of the big toe, causing it to drift toward the lesser toes over time. The usual result of this is a widened forefoot and a red, irritated bump on the side of the big toe joint. The redness and irritation is typically as a direct result of footwear which puts undue stress on the soft tissues in this area. While most bunions are due to faulty foot biomechanics (the forces going throught your feet in less than ideal positions, such as overpronation), conditions such as rheumatoid arthritis can lead to a bunion deformity.
Turf toe is a common sports-related injury, and like sesamoiditis, is characterized by pain on the bottom of the big toe joint. The pain stems from a sprain, which is an injury or tear of a ligament. This most commonly happens when the toe joint becomes hyper-extended, or bent back with excess force. Quick movements which change position, such as in soccer or football, are often the culprits. The name turf toe comes from the link between this injury and sports played on artificial turf, such as football and soccer. The conditions of the hard turf, athletic shoes, and stress on the toe from running may all contribute to this injury.
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 more debilitating long term complications.
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 anit-inflammatories can reduce inflammation and mild pain. You may also benefit from wider shoes, orthotics to control joint function, or the RICE method. RICE stands for Rest, Ice, Compression and Elevation, and it is commonly used to relieve pain from acute injuries. For moderate to severe pain, non-surgical methods available include:
Prescription-strength anti-inflammatory medication
Stretching exercises performed routinely
Prescription pain medication
Physical therapy (such as laser or ultrasound therapy)
Your treatment plan 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, or orthotics to off load and stabilize the joint and prevent progression of the deformity.
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 foot specialist, on a regular basis, especially if you have diabetes or spend a lot of time on your feet.
See a foot specialist at the first sign of symptoms. Often the earlier the problem is assessed, the faster it will respond to treatment!
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