Overview of big toe pain
Pain in the big toe joint also know as the 1st metatarsophalangeal joint is very common. There are multiple causes of pain in this joint including trauma, osteoarthritis, turf toe, gout, bunions, in-grown nails etc. The big toe joint is a relatively small joint that copes with a huge amount of repetitive load on a daily basis which is why it is not uncommon to see patients who suffer with pain or discomfort. Sports including running, rugby, football and hockey seem to have a high prevalence of big toe joint injuries as well as ladies wearing certain footwear including high heeled fashion shoes.
Causes and Symptoms of big toe pain
In-grown toenail - Pain at the end of the toe, often where the nail meets the skin, is often red, painful and sometime blood and/or puss can be visible
Bunion - This refers to the deviation of the big toe towards the lesser toes, often accompanied by a hard bony lump on the side of the big toe joint. Can be painful to bend, can rub on footwear, can lead to smaller toes being compressed or pushed up above the big toe.
Turf Toe - Usually seen in sports such as rugby, football, American football and hockey. This is where the joint is pushed past it’s available range leading to swelling, redness and pain on movement.
Osteoarthritis - When dealing with osteoarthritic change in the big toe there is usually a reduction in joint range. Ideally a big toe should bend up to 90 degrees. When the joint range is limited to 45 degree we refer to this as Hallux Limitus (hallux – big toe, Limitus – limited range). When the range is less than 10 degrees we refer to this as Hallux Rigidus. Pain is often noted when the big toe joint hits it’s full range when bent.
Gout - Sudden pain and stiffness, often swelling and redness is noted. The joint can become very hot and painful touch.
Trauma - This would be the result of a bump or a knock, often followed by pain, swelling and discomfort. If trauma results in a fracture the foot would be very painful to walk on and would require medical attention.
Sesamoiditis - The sesamoids are two bones that sit underneath the big toe. Sesamoiditis refers to inflammation of one or both of these bones. Specific pain is noted on palpation of underside of the big toe joint.
Treatments
Gait Analysis, orthotic therapy modular/bespoke, strength and rehab
Biomechanical Assessment
As podiatrists we specialise in lower limb pain and injury. We use biomechanical analysis as a way of understanding the anatomy of the foot and the complex mechanisms involved during movement. This will allow us to identify and diagnose many conditions in the foot and lower limb.
