Johanna Youner
Johanna S. Youner, DPM, board-certified foot surgeon in private practice in New York, an attending physician at New York Downtown Hospital, and a Fellow of the American College of Foot and Ankle Surgeons.
When it comes to pain in the big toe joint, there are many culprits. Some are minor, and you can use self-help steps such as rest, ice, compression and elevation (RICE) and over-the-counter anti-inflammatories to ease the pain. But when the pain lasts for more than a day, you may need a medical evaluation to determine the root cause and specific treatment, we hear from board-certified foot surgeon Johanna S. Youner, DPM.
Here are six reasons for pain in the big toe joint and the right steps to take next…
The most widespread reason for pain in the big toe joint is wearing problematic shoes, such as the wrong shape shoe for your foot. But even the right shoes can be a problem if they’re worn out. Example: You might not realize that your workout shoes have lost their cushioning if they still look good on the surface. It is best to replace them every six to eight months. And doing strenuous activity in inappropriate shoes also can lead to big toe joint pain. Examples: Wearing flimsy shoes for walking a long distance or three-inch heels for dancing the night away.
What to do: You can ease a simple sprain or strain with home therapy, such as a soak in Epsom salts…giving your feet a day off from heavy activity…and switching to a supportive sneaker.
You might associate arthritis pain with knees or hips, but this degenerative condition can affect the feet as well. Arthritis affecting the big toe joint—known as hallux rigidus—is the most common arthritis of the foot. When this joint gets rigid and fuses, it can cause a lot of pain.
What to do: Switch to shoes that better support and cushion the feet, such as a good running or walking shoe with a soft—not leather—sole for better shock absorption. Leather does not provide shock absorption.
Brands to try: Asics, Hoka, Rockport and New Balance. You also might also benefit from a custom orthotic, made by a podiatrist or orthotist, with a “first ray cutout” to reduce pressure on the joint and help you walk with less pain (the first ray is the foot segment just before the big toe, made up of the first metatarsal and first cuneiform bones).
In severe cases, when you also have bone spurs that make walking difficult, surgery might be necessary.
This inflammatory type of arthritis results when the body doesn’t properly process purines, a chemical naturally found in foods such as red meat, organ meat, seafood, high fructose corn syrup and beer. Ingesting these foods causes a spike in uric acid, a waste product that can collect as crystals in joints, often starting with the big toe joint. A gouty toe is unmistakable—the toe joint and the toe itself are extremely painful, red and swollen. Gout also causes throbbing pain in the big toe at night, especially after a purine-rich meal. Many people with gout know they have it and are under the care of a rheumatologist, but a first occurrence can lead you to see a podiatrist. Blood tests to check for uric acid levels and an X-ray can help with the diagnosis. Treatment includes a low-purine diet and medications to lower uric acid levels. During an intense gout attack, a cortisone injection can ease the excruciating big toe joint pain.
Big toe joint pain can be caused by a fracture from stubbing the toe or dropping a heavy object on it. People tend to minimize this type of trauma and may not see a doctor for weeks, but a fractured toe should be taped properly so that the entire injury heals, not just the bone but also any ligaments that were affected.
Another common type of injury: Turf toe, which affects the ligaments around the big toe and is common among athletes who play on artificial turf and repeatedly jam the big toe in their shoe. This also can happen to weekend warriors and women who wear stiletto heels for too long. Your health-care specialist will show you how to tape the toe joint to the second toe keep it from bending and giving it time to heal.
This foot deformity appears as the joint at the base of the big toe starts to protrude outward, causing the big toe to shift inward toward the second toe. A bunion often is the result of your natural biomechanics (the big toe is where the body pushes off with every step), but it can be worsened by being overweight, wearing the wrong shoes and doing activities that put lots of pressure on the feet.
What to do: Don’t put off seeing a podiatrist when a bunion starts to form. It may not hurt in the early stages, and a podiatrist can help slow the progression. Conservative therapies including orthotics and cortisone injections can help. For extremely painful bunions, surgery is an option, but it involves a long recovery starting with six weeks of putting no pressure on the foot.
This painful inflammation of the tendons occurs around the two little sesamoid bones on the bottom of the foot below the big toe joint. More common in ballet dancers and athletes who put pressure on their feet for long hours, it also can occur in people with arthritis or high arches.
What to do: Getting an evaluation is important to determine if you have a sesamoid fracture, which can take between six months and a year to heal…even longer without care. In addition to rest and stopping any activities that make the pain worse, an orthotic with a first ray cutout can help.
