Author: Chloe Wilson - BSc(Hons) Physiotherapy
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.
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.
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 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
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
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
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
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
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
The correct treatment for toe joint pain will depend on what is actually wrong with the foot. 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.
There are a number of other less common causes of toe pain, which we will look at now.
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.
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.
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 a number of other less common 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
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.
Page Last Updated: 12/12/18
Next Review Due: 12/12/20