Pain that Is Deep Inside the Big Toe Joint.
Location of the Big Toe Pain
The most common injury of the big toe is in the joint where the big toe meets the foot. Most commonly the pain is felt deep inside the joint, but there may be some tenderness on top of the joint and toe.
- If the big toe hurts almost entirely on top, the injury is called Hallux Limitus.
- If the big toe hurts almost entirely on top and the joint id enlarged on top with limited ability to bend the toe upward, the injury is Hallux Rigidus.
- If the big toe joint hurts only on the bottom, is is Seasamoiditis injury.
- If the big toe hurts on the inner side of the joint toward the other foot and there is an enlarged joint, is it a bunion.
- If the big toe hurts at the joint near the back of the toenail, it is injured interphalangeal joint.
Description of the Big Toe Pain
The big toe pain is usually achy and starts as a dull feeling that grows.
Running and walking usually causes the pain to increase during the workouts as an achy feeling. In most cases, the pain decreases over several days of rest. The pain may be on the surface or on the joint, but it may also be surface pain or located near or on the bunion bump (if present).
Big Toe Pain that hurts with everyday activity and does not go away after resting from running / walking is more serious and should be evaluated by a doctor.
Less common is an intense throbbing pain that is especially noticed at night and is not directly related to workout, called Gout. This is the result of a process where production of a chemical that is normally present in the body, increases significantly. The big toe joint is a common target for this substance. The body then attacks the “crystals” of this chemical as if they were irritating foreign objects. This damages the normal tissue and causes pain, redness, and swelling. Any sore big toe can hurt at nigh and feel stiff upon awakening, but Gout pain is intense and increases at night.
Seasamoiditis is noted by pain on the bottom of the foot at the base of the big toe, beneath the joint, that may feel like bruising – sometimes with sharper pain qualities. Sometimes the area can swell and feel thicker. If this occurs, it is a worse injury, sometimes a fracture. See a doctor.
Causes of Big Toe Pain
Excessive pronation is the primary cause for runners. This is especially true when it occurs after the heel starts to lift – a condition called “propulsion pronation” or “late mid-stance pronation.” This often occurs inside the shoe and has no visible signs. The repetitive motion of running and walking, as the distance increases, results in irritation.
High-arched feet are more likely to put extra pressure on the ball of the foot under the big toe base. This triggers impact-caused sesamoid pain, and is not related to pronation.
Those with bunions are likely to have pain because the joint no longer works correctly. The size of the bunion is not related to the quantity of pain, however.
Gout can be triggered by the same motions that produce other types of big toe pain, but high Uric Acid levels must be present. Uric Acid is elevated by many factors. Certain foods, alcohol, medications, and an inherited inability to process Uric acid are causes.
Treatment for Big Toe Pain
- Anti-inflammatory medicine
- Anti-inflammatory injection
- Surgery if conservative treatments fail
When to Stop Running
The common sense guidelines apply to these injuries. Swelling, redness, inability to stride normally, increasing pain, and pain with daily activity – all are reasons to rest.
Consequences of Running or Walking Through Pain
Athletes often wait too long to seek help. The pain may be intermittent and not severe, often occurring only during longer workouts. The fear of surgery may also cause a delay in diagnosis. Unfortunately this denial allows a small progression of changes to the bones and possibly permanent damage to the joint surfaces – when they night have been treated. At this point, the only alternative may be surgery.
There is a small but real risk of permanent damage by pushing through a singly episode of pain. Sometimes the pain begins a few days before an important race. Realistically it may be worth the risk to attempt the race but be prepare to drop out if the pain becomes too strong.