Big Toe Pain

So what is the big deal with the big toe? (Around my neck of the woods we call it “The GREAT toe”). There is a lot of stuff going on in such a small area and it all can make your life miserable. When these problems show up, they can be significant. 

The joints, nails, and deformity of the big toe should not be the focus of your life. We can help you restore balance by treating and fixing your big toe pain. Contact our office to book your appointment today!

What Could be Causing Your Big Toe Pain?

There are many problems that can cause big toe pain, including:

Bunions

The joint (1st MPJ) is the biggest villain for Great toe problems. It is also the joint that gets the greatest force and pressure with daily walking.

Bunions come in 2 varieties. They are the evil twins of foot deformities. The traditional Hallux Abducto Valgus (HAV) is when the Great toe tilts towards the second toe. The Bunion bump is on the side of the joint. Hallux Limitus is when the great toe does not move upward more than 30 degrees and the bump is on top of the joint. This is also called a turf toe and can be related to a sports injury.

Most of the time a Bunion is from your biomechanics (how the foot works). You can blame your parents and grandparents for this. Joint destruction (aka arthritis), discomfort, and shoe restrictions will develop in time.

Foot Trivia

I have heard the term “Bunion” used to describe every bump in the foot. It is specifically for the big toe.

There is one exception and that is for a Bunionette/Tailors Bunion. This presents on the opposite side of the foot – the 5th metatarsal.

Treatment

There are 2 treatment options to deal with the evil Bunion twins. Three options if you consider doing nothing as a treatment.

The first is to use protection. This means leaving the foot alone and changing the shoe. You want a Mississippi – wide and deep shoe. Normal shoes do not work well with advanced Bunions. Custom Orthotics can slow the progression of an early deformity. Protection also includes reducing inflammation. This includes laser therapy, ice, and anti-inflammatory drugs (not my favorite).

The second option is changing or correcting the foot so it can work in a normal shoe. Correction means surgery. Your overall health and degree of pain are major considerations for this treatment. Correction does not mean splints. If you look at Facebook ads or watch late-night TV you will see endless ads for this type of product. You are welcome to try these and remember to contact my office when you realize they don’t work.

Fracture of the Big Toe

There is no getting around this – they are painful. A simple fracture does not involve the joint and is not shifted from the original position. Simple immobilization and early treatment will improve comfort and shorten recovery time shortened.

It gets more complicated if the fracture involves the joint or is displaced. There is a good chance that arthritis will develop or the toe will be deformed. The toe bones heal fast. When someone tells me an injury happened 3- 6 weeks ago the boat has already sailed. I cannot correct any malposition with conservative care.

Sesamoiditis

You may have not heard of this unless you have been unfortunate to experience it. These tiny bones are the Rodney Dangerfield of the foot. The Sesamoids are 2 gliding bones that sit under the 1st metatarsal head. They look like 2 headlights on X-ray. The position of the Sesamoid bones can change from a Bunion deformity. They can be injured or fractured by a compression type of injury.

With Sesamoiditis, tenderness is specifically under the metatarsal. It hurts more when the toe is moved upward. Sesamoids can be easily protected allowing a quick return to comfort. The downside is they can get large after an untreated injury. This can cause more problems down the road.

Gout

Gout is perhaps the most painful thing that can happen to this joint. It is a rapidly occurring inflammation with swelling, redness, and pain. Bed sheets on top of the foot will be torture. Swelling will be impressive and the temperature will be greater than a bad sunburn. Repeat attacks will lead to aggressive arthritis and joint enlargement. The Great toe is the most common site for a Gout attack.

Enough about the bones. The nail is the other bad guy when it comes to big toe pain and Great toe problems.

Ingrown Toenails

Our skin is a very accommodating organ. It puts up with a lot before it yells for help. Typically the skin will give several episodes of swelling and redness as a warning sign. If it does not get attention then the skin will declare war against the ingrown toenail. The body will treat the nail as a foreign object.

Treatment

There are 2 options.

  1. A small part of the nail can be removed to provide immediate relief.
  2. The extra wide border can be removed so it does not come back.

There is a 3rd option – ignore the problem AKA Tough Guy Syndrome.

Don’ts and Dos

  • Don’t soak in hot water. Bacteria thrive in a warm moist environment (like in a shoe).
  • Pain relievers and antibiotics are temporary. Remember it is a wide nail that is the problem – not the skin.
  • Don’t put cotton or any other material under the edge of the nail. It is taking up more space in an angry crowded area. It will act as a dance party for bacteria.
  • Don’t use any of the medieval-looking devices that claim to straighten the nail

The Golden Rule: Do not cut into the corner of a nail where you cannot see the ending edge. Be a smart guy, not a tough guy. No need to endure the pain an inflamed or infected nail border can provide. We love bathroom surgeons. They make a small fire into a bonfire.

Do: Get it treated ASAP

Thick Mycotic Nails

If the nails are discolored, brittle, and thick, you are dealing with a chronic fungal infection. The big toenail is the nail that is most affected. This is the toe that gets beat up the most and trauma is the primary source of fungal involvement. The nail will also get wide from the fungus so there can be double trouble in getting an ingrown toenail.

Treatment

There are several options for thick nails:

  1. If there is no pain, simply reducing the size of the nail will be helpful. See above- Do Not Cut into the corners.
  2. Addressing the cause – attacking the fungus. There is no good single treatment for fungal nails. We throw a 3 punch combo at it: oral medication, topical medication, and laser therapy. These treatments require motivation and patience to have a chance of succeeding. This treatment is the best hope of having a normal nail.
  3. If there is notable pain from the nail, then removal of the nail is an option. The intent is NOT to have the nail return. To see what a toe looks like when the nail is removed click here. This is a last resort if the previous 2 options are not helpful.

Want to Learn More?

There is more information than you ever wanted to know about nails on my website. Look under Things We Treat, Patient Info/Blogs, FAQs, and Videos/Skin and Nails.

These are the most common problems with the Great toe. Warts, hematoma (sub ungula) under the nail, callus, and wounds are a few other maladies that can occur.

Contact Us Today for Help with Big Toe Pain

We understand how stressful dealing with big toe pain and pain in the big toe joint can get, and we are here for you. You do not have to suffer until it is unbearable. Schedule an appointment with Dr. Leibovitz when you notice any issues. The earlier, the better!

Big toe pain caused-by an ingrown toenail
Big toe pain caused by a bunion