Why Does MY Big Toe Hurt? Potential Causes and Treatments

Traumatic Injuries (Sprains and Fractures)

Most of us have experienced trauma to the big toe, but injuries and repetitive stress do not always cause the same damage.

The bones in the big toe can certainly become fractured via a sudden hard impact, such as a forceful stub or dropping something on it. The toe may look severely bruised and swollen, and might even appear crooked or malformed. Pain tends to be intense, and you may have difficulty walking on the toe, which should be avoided!

The bones in the hallux can also develop hairline fractures along their surfaces as a result of repetitive impact (such as from running or other sports). A stress fracture can start as a dull pain that becomes worse and more tender over time. There may also be some swelling.

The big toe can also become sprained (often referred to as “turf toe”) when it is bent farther than it is designed to. This can cause considerable pain and tenderness due to the damaged ligaments and joint capsule.

Never delay in calling us if you suspect you have broken or sprained your toe. While such conditions usually do not require surgery or intensive treatment, it is important to ensure the toe heals properly to avoid chronic pain, instability, or other problems in the future. Remember your hallux is not just “another toe.” It is responsible for 60% of the balance in your foot.

Sesamoiditis

The big toe also contains two tiny bones that are not connected to any other bone. These bones, called sesamoids, are found within the flexor tendons on the bottom of the toe, providing increased leverage to aid in movement, strength, and balance. 

Like any other bone, the sesamoids can become weakened and fractured. This can cause an ache at the base of the toe and difficulty in bending it.

Rest, offloading weight, and cushioning should provide enough opportunity for a case of sesamoiditis to recover. Addressing the issues which led to the case in the first place can help prevent future injuries as well.

Bunions

If you have pain from a bunion, it will likely be easy to notice. The bony protrusion a bunion forms at the base of the big toe is hard to ignore – but pain may be present in earlier stages of this deformity when that bump is not so pronounced.

A bunion forms due to instability within the joint at the base of the first metatarsal (the metatarsal cuneiform joint). This instability allows the first metatarsal to shift and rotate over time, creating the bump which protrudes at the base of the hallux. As the rotation and protrusion of this bone increases, the big toe begins to drift toward the neighboring toes. 

Bunion pain and associated symptoms can often be managed in the early stage with conservative methods including splints, padding, footwear adjustments, and custom orthotics. In cases that are severe or unresponsive to these treatments, surgery may be necessary to provide relief.

Hallux Limitus and Hallux Rigidus

Hallux limitus and hallux rigidus are both conditions that affect the metatarsal phalangeal joint (MPJ) the latter being a more advanced form of the former.

Hallux limitus typically begins as pain and soreness in the joint, often after activity. The toe becomes stiff and more difficult to move over time, and you might even notice swelling or a hard bump developing on top of the joint. 

Eventually, the joint may become locked and unable to bend at all. This is hallux rigidus. 

Much like a bunion, early and effective treatment can help manage the symptoms of hallux limitus and prevent the condition from progressing to hallux rigidus, which usually requires surgery to effectively treat.

Gout

While various forms of arthritis can affect the joints within the big toe, gout is a unique form of this condition that tends to target the toe more often than other areas of the body.

Gout occurs when excess uric acid gathers and crystalizes within a joint and surrounding tissue. This can cause a sudden “flare” of excruciating pain, which usually develops overnight and lingers for several days. Your hallux and MPJ are typically red, hot and swollen. The pain is relentless and makes it difficult to find a comfortable position for the foot.

Why does gout tend to hit the big toe and why during the night? Because uric acid requires a lower temperature to crystallize. During sleep the body temperature drops slightly and since your toes are the furthest body part from the heart they tend to be cooler than the rest of the body (as you might sometimes feel when your feet are cold).

Medication and diet are the two most significant keys to preventing gout attacks. Avoiding foods high in purines, which break down into uric acid, is essential. This often means limiting the intake of alcohol, red meats, shellfish, and certain vegetables, among other items.