by Last updated on March 7th, 2024 at 07:42 pm
During gait, your feet come under extreme pressure. The vertical force is north of 120% of the body’s weight when walking and 275% when running; this is even greater in young people (1). A significant proportion of this force goes through the big toe, and as you can imagine, it can cause problems in the short and long term.
It’s further exacerbated if you do other high-impact activities, such as playing or participating in jumping sports. Moreover, the footwear people use often does not support the foot biomechanically. No wonder many individuals suffer from big toe pain.
In this article, we will look specifically at some of the causes of pain on top of the big toe joint. We will also go over prevention strategies. That is, what can be done at home to treat the pain, tips for living with the condition, risk factors, prognosis, diagnosis, when to see a doctor, questions your doctor may ask you and questions to ask your doctor. OK! let’s get stuck in!
Injury or Trauma
The most common cause of pain on top of the big toe joint is an injury or trauma to the area. This can occur due to a fall, banging your foot or toe, stubbing your toe, a sprained metatarsophalangeal joint or playing high-impact sports. Repetitive stress injuries can also cause trauma leading to pain on top of the big toe joint.
These usually occur from overuse of the joint and can be seen in people such as long distances runners or those who wear ill-fitting shoes. This type of pain is generally associated with symptoms that get worse with activity, swelling, redness and warmth in the area. A disability may also be present. It is essential to seek medical attention for such injuries, as they can get worse over time, leading to further complications.
Arthritis
Arthritis is another common cause of pain on top of the big toe joint. Several types of arthritis can affect this area. The main one, in this case, is osteoarthritis. Osteoarthritis is a degenerative disease which means that it gradually gets worse over time.
The wear and tear of the cartilage in the joint is the leading cause. This can occur due to injury, repetitive stress or simply from ageing. The symptoms include pain, stiffness, swelling and deformity of the toe. In some cases, the pain may be severe enough to limit weight-bearing activities.
Osteoarthritis can cause conditions such as hallux limitus and hallux rigidus. Hallux limitus is a condition where the range of motion in the big toe joint is limited due to the loss of cartilage. While hallux rigidus is deformity and pain in the big toe joint caused by an overgrowth of bone, which usually prevents movement at the joint.
The overgrowth of bones mentioned earlier is called osteophytes or osteophytic lipping. You can sometimes feel it if you palpate the joint line. For many people, it is not a cause for great concern but for others, it can be disconcerting and painful, especially when wearing shoes.
Gout
If you have had gout in the past am sure it’s not an experience you want to relive. Gout is a form of arthritis that can also cause pain on top of the big toe joint. It is due to a build-up of uric acid in the body, forming crystals in the joints. These crystals can cause inflammation, swelling and pain. The symptoms tend to come on suddenly and can be very severe.
Gout can attack any joint in the body, but it usually affects the big toe joint. The reason is still not adequately understood. Some researchers have suggested that it may be due to the trauma that the big toe undergoes compared to other joints. With that said, if you are experiencing sudden severe pain in the big toe joint of unknown origin, it could be gout, and you may need to see your physician for treatment.
Psoriatic arthritis
Psoriatic arthritis is a type of arthritis seen in people who have psoriasis of the skin. It can affect any joint, including the big toe joint. The symptoms are similar to other types of arthritis, including pain, stiffness and swelling of the joint. In some cases, the nails may also be affected by psoriatic arthritis.
The exact cause of psoriatic arthritis is unknown. However, it is thought to be a combination of genetic and environmental factors. If you have psoriasis, it’s vital to be aware of the symptoms of psoriatic arthritis, as early diagnosis and treatment are essential to good clinical outcomes.
Bunions
Many bunions are asymptomatic, and people often worry more about how the bunion looks. Nevertheless, bunions can be a source of great pain due to the deformity they cause at the big toe joint. Bunions occur when the big toe points in towards the second toe, and the 1st metatarsal (long foot bone) points outward, causing the joint to protrude.
The cause can be due to several factors, including genetics, ill-fitting shoes, hypermobility and arthritis. Some conditions, such as rheumatoid arthritis, may predispose an individual to develop a bunion.
The symptoms of a bunion include pain, swelling, deformity and redness. The big toe joint may also be stiff and difficult to move. If you have a bunion, it is essential to seek medical advice as they often worsen over time and may eventually require surgical correction.
Bursitis
Bursitis is the inflammation of a bursa. A bursa is a small sac of fluid that acts as a cushion between bones and tendons. Bursitis can occur at any joint in the body but is more common in the shoulder, elbow and hip. The big toe joint can also be affected by bursitis.
It is not uncommon to have bunion pain with the presence of bursitis. Although the bursa is found at the side of the great toe towards the body, you will feel it on top of the big toe joint if it’s pretty inflamed. This is known as referred pain.
Bursitis is usually due to overuse or repetitive motion. It can also be due to an injury or infection. The symptoms of bursitis include pain, swelling and tenderness around the affected joint. The joint may also be stiff, and you may have difficulty moving it. See a foot specialist if you think you have bursitis.
Lesser toe deformity
Lesser toe deformity is more likely to affect the neighbouring toes than the big toes. Nevertheless, the big toe is not immune from such problems. The great force that goes through the great toe makes it very susceptible to developing a myriad of deformities.
There are many different types of lesser toe deformity. However, they all share the common features of pain, deformity and difficulty moving the affected toe. The most common type of lesser toe deformity is a hammertoe, where the toe is bent at the middle joint, causing it to resemble a hammer.
Other types of lesser toe deformity include mallet toe, where the toe is bent at the joint closest to the nail and claw toe, where the toe is bent at both the middle and end joints. Ill-fitting shoes often cause lesser toe deformities, but they can also be due to genetics, arthritis or diabetes.
If you have a lesser toe deformity, it is crucial to seek medical advice. The condition can often worsen, leading to more pain, and you may eventually require surgery to correct it.
Corns and calluses
Inappropriate footwear has resulted in corns and calluses becoming common foot problems affecting the big toe. Corns are small circular areas of thickened skin that develop when the skin is exposed to too much pressure. Calluses are larger areas of thickened skin that develop in response to friction. Both corns and calluses can be painful.
These hard skin on the big toe often develop in response to ill-fitting shoes. However, bunions and hammertoes can also cause them. These two pathologies significantly predispose the skin above the joint and tip of the toes to corns and calluses, which can be very debilitating and painful from my experience in treating patients.
Corns and calluses can be treated at home with over-the-counter products. However, if they are severe or do not respond to treatment, you may need to see a podiatrist or another care provider.
Ingrown toenails
How can an ingrown toenail cause pain on top of the big toe joint, given that it affects the sulcus (the corners of the toe)? Well, an ingrown toenail is a condition where the nail grows into the flesh of the toe, causing pain, redness, swelling, and infection, which can cause referred pain to be felt at the big toe joint.
Ingrown toenails are more common in the big toe than in any other toe. This is because the big toe is subjected to a lot of weight and pressure when we walk, making it more susceptible to trauma. Some people may also have involuted nails, predisposing them to develop an ingrown nail.
Ill-fitting shoes, incorrect nail-cutting techniques and poor foot hygiene can also contribute to the development of ingrown toenails. The symptoms of an ingrown toenail include pain, redness and swelling around the affected toe. The toe may also be tender to touch, and disability may also be present. Again, see a podiatrist for treatment if you have an ingrown toenail.
Fracture
Often, when individuals think of pain on top of the big toe joint, a fracture is not always the first thing that comes to mind. A fracture is a break in the bone. Fractures can occur anywhere in the body, including the bones of the foot. The big toe bones are one of the most commonly fractured bones in the foot. Again, this is because it bares much weight and comes under tremendous pressure during gait.
Fractures can be caused by direct trauma to the bone, such as a fall or accident, or by indirect trauma, such as repetitive stress, when participating in high-impact activities such as running, sprinting, and jumping. Symptoms of a fracture include pain, swelling and bruising around the affected area. The toe may also appear deformed.
If you are getting pain around the big toe joint and you suspect it could be a fracture, you must see a healthcare provider for an X-ray to confirm the diagnosis. However, if it’s a hairline fracture, it may not show on an X-ray immediately.
According to Einhorn and Gerstenfeld (2015), a hairline fracture may take a few weeks to show up. This may be due to the relative size of this type of fracture, which makes it hard to see. It becomes evident a few weeks later when the anabolic phase, which increases tissue volume resulting in collagenous callus formation, starts (2). In other words, it is healing and therefore, can be picked up by an X-ray.
Extensor hallucis tendonitis
The extensor hallucis tendon is a long fibrous rope-like tissue that runs along the top of your foot and attaches to the top of your big toe. It helps with raising (dorsiflexing) your big toe when you walk. Inflammation or degeneration of this tendon is termed tendonitis or tendinopathy respectively.
Extensor hallucis tendonitis can cause pain on top of the big toe joint as well as referred pain elsewhere. It is a common condition that can be caused by overuse, such as excessive running or jumping or inappropriate footwear.
Symptoms of extensor hallucis tendonitis include pain and tenderness along the top of the foot and big toe, swelling and stiffness in the big toe. The toe may also be tender to move. Treatment includes rest, ice, and over-the-counter anti-inflammatory medications (NSAIDs).
Wearing shoes with a deep and wide toe box, a rocker bottom and a fastener can also help to relieve symptoms. If you have tendonitis that is not responding to treatment, you may need to see a care provider for further evaluation. They may recommend corticosteroid injection or other forms of treatment.
Extensor hood damage
As its name suggests, the extensor hood appears like a hoodie that covers the toes. It’s also referred to as extensor aponeurosis or expansion. The extensor hood comprises thickened, wide fibrous or connective tissue that narrows as it attaches to the tendons on the top of your toes or phalanges. It helps with movement and provides stability to your toe joints from muscle force.
Damage to this structure can cause pain on top of the big toe joint. The most common cause of extensor hood damage is trauma, such as an accident or injury. Damage to the extensor hood is rare. Symptoms include pain, swelling and bruising at the big toe joint. The toe may also be difficult to move due to subluxation of the tendon associated with it. Treatment includes rest, ice, and over-the-counter anti-inflammatory medications. Also, a rocker bottom footwear may be of help. Keep in mind that corticosteroid injection can degenerate the tissue and make it susceptible to damage if used.
If you think the symptoms you are getting could be extensor hood damage, you may need to see a doctor or podiatrist for further evaluation. They will be able to recommend the appropriate treatment.
FAQs
How can pain on top of the big toe joint be diagnosed and treated?
Your clinician will take a history and perform a physical examination. They may use a special test such as the Jack’s test to help diagnose the problem. Jack’s test by itself is not diagnostic. However, it can check for limitations at the big toe joint and assess the windlass mechanism. Imaging studies such as X-rays may also be ordered to rule out fractures. Ultrasound or MRI may be used to evaluate for tendonitis or nerve entrapment.
What can people do to prevent or reduce pain on top of the big toe joint?
There are several things people can do to prevent or reduce pain on top of the big toe joint:
- They should wear shoes that fit well and provide adequate support.
- They should avoid high-impact activities if they have a history of problems with their feet or toes.
- They should warm up before participating in any activity and cool down afterwards.
- If they are overweight, they should consider reducing it to an appropriate level.
- They should stretch their calf muscles regularly.
Are there any home remedies for reducing pain on top of the big toe joint?
Several home remedies may help reduce pain on top of the big toe joint if it is musculoskeletally related:
- You can rest and elevate the feet and place an ice pack on the area for 20 minutes daily.
- You can take over-the-counter anti-inflammatory medications such as ibuprofen or naproxen.
- If it is a chronic problem, you can soak your feet in a warm bath with Epson salt for 10 minutes.
- It would help if you stretched your calf muscles regularly.
If the pain is caused by an infection, wound or something else, please seek professional help as soon as possible.
When should someone see a doctor or podiatrist for pain on top of their big toe joint?
You should see a doctor or podiatrist if you have pain on top of your big toe joint that does not go away with home treatment, if you have diabetes or another condition that affects your feet, if the pain is severe, or if you cannot bear weight.
Questions your doctor or care provider may ask you
Below are some questions your clinician may ask to better understand your problem and to aid in diagnosis and treatment.
- What are your symptoms?
- When did you first start experiencing these symptoms?
- Do you have any other medical conditions?
- Do you take any medications?
- Do you have a history of injury to this area?
- Do you have a history of problems with your feet or toes?
- What activities do you participate in regularly?
- Have you tried any treatments so far, and how effective were they?
- Does anything make your symptoms better?
- What makes your symptoms worse?
Questions to ask your doctor or care provider
After your care provider has had a chance to evaluate your problem, here are some questions you may want to ask them.
- What is the most likely cause of my symptoms?
- Are there any other possible causes?
- What tests do I need?
- How will this condition be treated?
- What are the risks and side effects of the treatment?
- What are the long-term effects of this condition?
- How can I prevent this condition from getting worse or coming back?
- Is there anything else I need to do to take care of my feet or toes?
- When can I expect my symptoms to improve?
- When can I expect my symptoms to go away completely?
Conclusion
I suspect the article was of benefit if you read up to this point. Well done! Pain on top of the big toe joint can have many causes, such as overuse, arthritis, infection, among others. There are many treatments for pain on top of the big toe joint, depending on the cause. Rest, elevation, ice, and over-the-counter medications may help relieve symptoms in the short term. In the long term, stretching and strengthening exercises may be recommended as preventative measures. It is essential to seek professional help if the pain does not go away with home treatment or if you have other medical conditions. Your care provider will tailor a treatment plan for you. Remember, your health is your wealth! For other toe pain causes.
