Our feet are complex structures comprising numerous bones, joints, muscles, tendons, and ligaments. As the primary structure necessary for push-off during normal gait, the hallux, or big toe, takes the brunt of our daily activities. This means that it is the last part of the foot to leave the ground with each step.

Big toe pain can sometimes extend from deep inside the joint; at other times it is localised to the nail. Whatever the cause, big toe pain can become extremely bothersome for those who need to walk or stand for long periods.

Delays in treatment can sometimes lead to morbidity, possibly requiring amputation.

Causes of the Pain?

Because pain in the big toe is a symptom, there could be numerous reasons for it. Common causes of big toe pain include:

• – Gout
• – Vascular disease
• – Bone tumour
• – Structural deformity in toe
• – Inflammation of the tendons and ligaments surrounding the hallux
• – Obvious injury
• – Ingrown toenail
• – Fracture
• – Bunion
• – Osteoarthritis
• – Rheumatoid arthritis

If you have already been diagnosed with one of these conditions, you have probably been told that hallux pain is a common symptom, especially with gout, bunions, and hallux rigidus.

However, if you have never been diagnosed with any of these conditions, have not been injured, and have never had previous symptoms, you should seek medical attention immediately. Treating the underlying cause can usually relieve big toe pain.

Symptoms

Hallux pain can be the result of an underlying problem. Other symptoms that sometimes accompany it include:

• – swelling
• – redness or discolouration
• – drainage
• – cold digit
• – pain after rest
• – pain with movement
• – difficulty with footwear
• – stiffness in the joints
• – bruising

The underlying cause may be important. If swelling and bruising accompany the pain, there is a good chance that an injury has occurred, especially if the pain came on suddenly and was associated with trauma.

If there is sudden discoloration or a cold digit, then there may be a more serious underlying cause, possibly a distally lodged blood clot that could have come from the heart, or blockage of the arteries, causing ischemia (restriction of blood supply to the tissues), and necrosis of the digit.

Nail pain accompanied by obvious drainage, redness, and swelling,  may indicate an ingrown toenail that has become infected.

Sudden pain and redness localised to the first metatarsal phalangeal joint (i.e., the tip of your toe), may be a result of increased uric acid levels, meaning a gout attack. Joint pain may be caused by underlying osteoarthritis, or by a more serious condition, such as a bone tumour.

Unless you have a clear cut explanation for your pain, it is best to have your pain diagnosed by an orthopaedic surgeon before the condition worsens.

How Is Big Toe Pain Diagnosed?

When you first meet with your physician, you will be asked questions about your symptoms, activities, and medical history. These questions will help to diagnose you correctly.

You will be given a physical examination, and may be required to submit a blood sample for testing, to rule out conditions such as gout or an infection. You may also be given an x-ray or additional imaging tests (MRIs, CT scans), to help rule out a broken toe, or damage to the surrounding tissues. Once a proper diagnosis is made, treatment can begin.

Treatment

It will depend heavily on the cause and severity of the pain. Over-the-counter pain medications such as ibuprofen can reduce inflammation and mild pain.

You may also benefit from wider shoes, orthotics, or the RICE method. RICE stands for Rest, Ice, Compression and Elevation, and it is commonly used by athletes to relieve pain. For moderate to severe pain, non-surgical methods available include:

• – Prescription-strength anti-inflammatory medication
• – Stretching exercises performed routinely
• – Prescription pain medication
• – Corticosteroid injections
• – Physical therapy

Your doctor’s recommendation will depend on the cause of your 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.

If you are suffering from poor circulation, you may need to follow up with a vascular specialist. For  an infected ingrown toenail, you will need to be placed on antibiotics and have the nail border removed.

Prevention 

Here are some tips to help you prevent big toe pain from occurring or recurring:

• – Wear shoes that fit you properly, which 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 podiatrist on a regular basis, especially if you have diabetes, or spend a lot of time on your feet.
• – See a podiatrist at the first sign of symptoms.

 Your feet mirror your general health . . . cherish them!