Toe Joint Pain

Written By: Chloe Wilson - BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board

Toe Joint Pain: Common Causes, Symptoms, Diagnosis and Treatment Options

Toe joint pain is a common problem.  It can affect any number of toes but most commonly causes big toe joint pain.

This is hardly surprisingly as when we walk 90% of our body weight goes through the big toe, also know as the hallux.

Toe pain may indicate problems in the bones e.g. a fracture, soft tissues e.g. tendonitis, nails e.g. ingrown toenail or skin around the toes e.g. infection.

For treatment to be effective, we need to know what the underlying cause of the problem is so we can treat that and the associated symptoms, otherwise the problem may recur.

Common Causes of Toe Joint Pain

So let's start by having a look at the most common causes of toe joint pain and how they present. You'll find a brief overview of each - to find out more, go to the full article. We will finish by looking at some of the more rare causes of toe joint pain.


Gout Foot

Big toe joint pain is often caused by gout

A type of inflammatory arthritis that typically affects the big toe. Repeat flare-ups common

Symptoms: Sudden onset of intense pain, usually at night, inflammation and redness

Causes: High levels of uric acid due to diet, medication, genetics, obesity & medical conditions

Full Article: Gout Foot


Hammer, Mallet & Claw Toe

Claw, mallet and hammer toe are common causes of toe joint pain

Hammer Toe: middle toe joint bends down so toe arches up.  

Mallet Toe: Tip of the toe bends down stopping the toe from straightening 

Claw Toe: Middle and end toe joints bend down curling the toe into a claw shape.  Often affects multiple toes

Full Article: Toe Deformities


Foot Bunions

Bunions are a common cause of big toe joint pain

Big toe gradually deviates inwards pushing the base of the toe outwards

Symptoms: Hard lump develops on outer side of the big toe. Toe starts to cross over neighbouring toes. May or may not be painful

Causes: Tight, pointed, high heeled shoes, genetics, arthritis

Full Article: Foot Bunions


Tennis Toe

Tennis Toe is a common cause of toe pain with blood pooling under the nail

Damage to the big toe in which blood pools under the toenail

Symptoms: Throbbing toe pain, red/black nail

Causes: Toe repeatedly jamming against the front of a shoe, typically sporting activities where change direction quickly e.g. tennis

Full Article: Tennis Toe


Turf Toe

Turf Toe is a common sporting injury. Find out about the causes, symptoms, diagnosis & treatment

Damage to the ligaments at the base of the big toe

Symptoms: Big toe joint pain, stiffness and inflammation

Causes: Hyperextension injury - big toe bends back too far, playing sport on hard, artificial surfaces

Full Article: Turf Toe


Ingrown Toenail

An ingrown toenail develops when the curled sides of the nail push into the surrounding skin caused toe pain and inflammation

Curved edges of toenail curl and cut into the surrounding skin

Symptoms: Toe pain, redness, swelling and oozing

Causes: Poor foot care, injury, tight shoes, incorrect nail cutting technique

Full Article: Ingrown Toenails


Blisters

Blisters are a common cause of pain in toes

Small fluid-filled pockets form on damaged areas of the upper layers of skin

Symptoms: Bubble-like swelling filled with fluid - clear, yellow or black, tender

Causes: Friction, intense heat or cold, medical conditions, chemicals

Full Article: Foot Blisters


Treating Toe Joint Pain

The correct treatment for toe joint pain will depend on what is actually wrong with the foot. Typical things that help include:

  • Exercises: strengthening and stretching the foot and ankle
  • Orthotics: inserts for your shoes to correct foot position
  • Steroid Injections: to reduce pain and inflammation
  • Ice Packs: to reduce pain and inflammation
  • Supports: tubigrip compresion bandage or ankle/foot supports of splints
  • Toe Stretchers: specially designed inserts that sit between your toes

You can find out lots more about the treatment options for each of these types of toe joint pain by reading the full articles mentioned above.


Other Causes of Toe Joint Pain

There are a number of other less common causes of toe pain, which we will look at now.

Morton’s Neuroma

Morton's Neuroma commonly causes pain, tingling and numbness between the toes. Image source https://orthoinfo.aaos.org/en/diseases--conditions/mortons-neuroma

Morton’s Neuroma is a condition affecting the nerves that run between the toes, causing toe joint pain, tingling and numbness between your toes and underneath the foot.  Many people complain that it feels like there is a small stone underneath their foot. 

Morton’s neuroma is caused by a thickening in the tissue which surrounds the nerve which irritates and compresses the nerve.  This may be due to other foot problems such as bunions, hammertoe and flat feet or wearing tight or high-heeled shoes.

It most commonly develops between the 3rd and 4th toe, but can occur between the 2nd and 3rd toe. 

Treatment consists of rest, painkillers, injections, orthotics (shoe insoles) and occasionally surgery.

Full Article: Morton's Neuroma: Causes, Symptoms & Treatment

Toe Arthritis

X-ray showing arthritis of the big toe.  Image in the red box shows a normal big toe x-ray.

Arthritis is another possible cause of toe joint pain. The most common place to get arthritis in the foot is at the base of the big toe in the metatarsophalangeal joint (MTPJ). 

The big toe is continually bending up and down as we walk making it prone to wear and tear.  With arthritis, the cartilage that lines the MTPJ gets damaged and osteophytes (small lumps of bone) form.  This results in stiffening of the big toe, known as hallux rigidus. 

Common symptoms of arthritis include big toe joint pain, especially during the push-off phase of walking, inflammation and stiffness limiting how much the big toe can bend up.  A bunion may develop on the toe. 

Toe arthritis may be linked with foot injuries or episodes of gout, but often develops with no obvious cause. Treatment consists of pain relief, ice, steroid injections and orthotics such as a rocker bar which fit on the sole of your shoe so you don’t have to bend the toe up when walking. 

If symptoms get progressively worse, surgery may be required to either trim some of the bone, fuse the joint or replace it altogether with a prosthesis.

Sesamoiditis

Underneath the big toe are two small pea-shaped bones, known as sesamoid bones which sit inside the tendons that run to the big toe.  They work like a pulley for the tendons to move the toe and play an important role in the push-off phase of walking. 

Sesamoiditis occurs when there is inflammation of the sesamoid bones and surrounding tendons.  This is usually caused by frequently wearing high-heeled shoes, activities that place lots of pressure through the ball of the foot such as ballet or suddenly increasing activity levels where you put more pressure on the ball of your foot such as running.

The most common symptoms are big toe pain, particularly underneath the toe and in the ball of the foot which develops gradually over time, comes and goes and gets worse when you are on your feet.  It may be painful to move your big toe and occasionally there may be some swelling or bruising. 

Treatment focuses on reducing the pressure through the area by wearing comfortable shoes, using padded shoe inserts or taping the big toe as well as reducing the big toe joint pain and inflammation with rest, regular ice treatment and occasionally a steroid injection.

There are also a number of rare causes of toe joint pain:

1) Fractures: A break in one the toe bones either from trauma or repetitive stress
2) Blue Toe Syndrome: A condition where a blockage in the small blood vessels of the foot reduces blood and oxygen flow.  The toes characteristally turn blue and are extremely painful
3) Vascular Disease: Narrowing of the arteries reducing the blood and oxygen flow to the legs and feet
4) Toenail Problems: Thickening and discolouration of the toenails may be due to a fungal infection or underlying medical condition
5) Diabetes: People with diabetes are more susceptible to foot problems due to damage to the blood vessels and peripheral nerves
6) Capsulitis: Inflammation of the joint capsule, the fluid filled sac that surrounds the synovial joints of the toes
7) Tumours: Tumours in the foot bones are extremely rare accounting for 3-6% of all bone tumours 

What Next?

You can find out more about these common causes of toe joint pain by clicking on the links above.  Alternatively, if your pain is spreading to the rest of the foot, visit the foot pain diagnosis section for help working out what is causing your pain.

  1. Foot Pain Guide
  2.  ›
  3. Diagnosis Guide
  4. Toe Pain

Page Last Updated: 2019-11-05
Next Review Due: 2021-11-05


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