What is toe pain?

Toe pain is an uneasy sensation found in various areas of the toes and can also affect the foot. The feet and toes are made up of bones, joints, muscles, and soft tissues, which enable us to perform activities such as walking, running, and jumping. The forefoot consists of five toes (phalanges) and five long bones (metatarsals).¹ Can you believe these bones are  and can even be broken from stubbing your toes on the side of furniture?² Most common toe pain is experienced in the big toe, little toe, and second toe. Injuries or infections to any of these structures could cause developmental pain; however, toe pain can occur for various reasons, which will be covered in this article.

What are the causes of toe pain?

The most common causes of toe pain are ingrown toenails, bunions (hallux valgus), cuts, scrapes, blisters, corns, and calluses. Additionally, toe pain can also occur due to increased old age. By the age of 50, you may have traveled at least 75,000 miles by foot or more.³  As we grow older, the wear and tear of our bones, tendons, muscles, and ligaments become painful. Which can occur in your toes, feet, and ankles.

Apart from medical causes of toe pain, stress or ‘cold feet’ can be a main contributing factor to toe pain. When you are stressed out, it can cause the blood to circulate away from your feet. The lack of blood circulation produces stiff or tingling sensations in your feet.⁴ Additionally, a broken foot or feet may lead to toe pains.

Root causes of a broken foot include:

• Car Accidents- Crushing injuries can cause breaks in the bone, impacting the toe, leading to toe injuries. To treat this, you may require foot surgery or ankle surgery
• Falls, trips, and Slips can break bones in your feet
• The impact of dropping something heavy on your feet can cause fractures
• Misstep- misplacing your foot in a certain way can lead to a broken bone
• Overusing feel may lead to a stress fracture. A stress fracture is tiny crack in a bone or severe bruising within a bone. This is usually caused due to overuse and repetitive activity. Athletes and runners commonly experience this due to participating in running-intensive sports such as football and basketball.⁵ However, normal activity or use of the bone that is weakened by osteoporosis can heighten a stress fracture

What are the signs and symptoms of toe pain?

The signs and symptoms of toe pain will vary according to the underlying causes of the disease. However, these are the common symptoms that are experienced when having toe pain:

• Pain
• Swelling around the nail or nail curls (Ingrown toenail)
• Bony hard lump near the big toe (Bunion)
• Numbness or tingling due to stress or feeling cold, discolouration of the skin. (Raynaud’s or chilblains)
• Sudden pain or stiffness, noticeable red of hot swollen skin near the toe joint. (Gout)

Toe pain can develop as a result of serious health conditions. Therefore, if you are not sure what the problem is. It is good to seek medical help as soon as possible, whether for toe pain, foot pain, heel pain or ankle pain.

What are the different types of toe pain?

Big toe pain

Big toe pain is caused due multiple reasons, such as injury or a minor underlying medical condition such as Arthritis, fractures, and gout may cause big toe pain. If not treated effectively, toe pain could lead to further complications. The types of conditions leading to toe pain are listed below.

Arthritis

Arthritis is a generic term that means the inflammation of joints. Arthritis is another term that refers to joint pain or joint disease. Arthritis can affect people of all ages, races, and gender. ⁶ Although, arthritis is not a disease caused due to age factors. Some types of arthritis occur more often in older people than younger people, such as rheumatoid arthritis.⁷

A Common Arthritis:

Osteoarthritis (OA) is identified as the wear and tear of arthritis and is the most common type of arthritis. This arthritis can affect almost any joint. OA is known to deteriorate the cartilage, changes bone shape, and causes inflammation, resulting in pain, stiffness, and loss of mobility. OA can affect the feet by causing pain and tenderness in the big toe and potential swelling to ankles and toes. ⁸ 

Research has supported that the prevalence of OA is more prominent in older adults; for example, a study showed that 44% of people who were 80 or older experience osteoarthritis of the knee. ⁹ However, you can prevent joint problems! 

This can be done by staying active and eating healthy.

Regarding the  American Orthopaedic Foot & Ankle Society, the hallux rigidus is the main contributor to arthritis pain at the base of the big toe. Common symptoms experienced in these areas are pain during walking or any physical activities that put pressure on the foot and toe. The other symptoms consist of swelling close to the joint of the big toe, a painful lump on the top of the joint, and being unable to move the big toe. Hallux rigidus affects 1 in 40 people over the age of 50 and usually starts to develop at the age of 30. Big toe arthritis most likely affects women in comparison to males.¹⁰ 

Symptoms: Big toe joint pain while being active. Visibly there is swelling around the big toe joint alongside difficulty bending or even moving the toe.

Causes: The causes of hallux rigidus are unknown. Excessive wear of the joint can lead to arthritis.

The treatments for the hallux rigidus may include surgical and nonsurgical options such as:¹⁰ 

Nonsurgical for the treatment of hallux rigidus includes pain relievers, anti-inflammatory medicines, and ice or heat packs to minimize pain. Platelet-rich plasma injections in the joints are found to be very effective. Practical tips such as changing footwear. Wearing thin-soled or high heel shoes may aggravate these conditions; hence, avoiding these shoes take pressure off the top of the joint. Shoes such as stiff soles, and curved soles can decrease the join pain. Wearing shoe inserts or arch supports can form a natural arch that prevents a lot of motion in the MTP joint. All of the above can decrease the symptoms.

When there is mild to moderate damage, surgically removing the bone spur on the surface of the foot or big toe can help massively. This procedure is called cheilectomy. The reason for the surgery to be carried out is when removing the bone spur enables the toe to bend, allowing pain relief. Other areas of the bone are also cut so that the big toe can change position of the big toe. As a result, it releases pressure off the joint.

Bunion

A bunion, also known as hallux valgus, is a bump that forms on the joint or at the base of your big toe. A bunion specifically is a bony lump that forms (hallux valgus), and is noticeable as your big toe appears to bend towards the other toes. Bunions are identified as the most common deformities in the forefoot with a spread rate of 23% to 35%.¹¹ The bone and the base of this bone get pushed towards the side and visibly stick out. This movement of the bone leads to pain and can make walking difficult. Bunions are common in adults, and as you grow older, they are found to develop more in females more them males.¹²  

Symptoms: include pain in the joints of toes, red/swollen big toe, and foot pain i.e. under the ball of the foot.  

Causes: The causes of bunions are unknown. However, some things can make you more likely to have it.  

• Flat Feet/Flat-footed or if you roll your feet inwards when you walk
• Bunions can run in the family or can be congenital, which means it can be an abnormality that is present at birth or may run be hereditary.¹³ However, it is shown by research that bunions may be caused due to the type of shoes¹¹  
• Long term conditions that target joints, such as rheumatoid arthritis or gout, may make you more prone to developing a bunion
• Foot injuries, strokes, or multiple sclerosis could potentially also may you more prone to a bunion 

Bunions can get bigger over time, especially if you are experiencing foot pain. You may find it uncomfortable and painful to walk. The skin over the bunion can blister or get infected due to the shoe you wear and the friction between your skin and your shoes. A bunion can form a fluid-filled space (bursa) under your skin. If this swells up, it can feel excruciating, called bursitis.  

Prevention:   

• Wearing wider shoes to ease the pressure on the joints  
• Having shoes that have a lower heel than 4 cm, so there is less push forward  
• Adjustable shoe laces or straps to hold your feet in place

Treatment:  

• Painkillers can reduce the pain  
• Bunion Surgery (called bunionectomy) may be considered if the bunion is getting extremely painful; if your second toe is affected by the bunion; struggling to find shoes that fit; affecting your daily life

Ingrown toenail

Ingrown nails also known as onychocryptosis, can cause 20% of foot problems in primary care.¹⁴ Ingrown toenails occur when the periungual skin, which is the skin adjacent to the nail, is affected by the side or corner of the nail growing into that soft flesh.¹⁵  

Symptoms: Pain, soreness, tenderness, inflamed skin, infection, and swelling  

Causes:   

• Tight shoes  
• cutting toenails too short or not straight forming pointy edges  
• Injuries to toenail  
• Curved toenails  
• Nail infections  
• Certain medical conditions  

Preventions:¹⁶  

• Carefully trim toenails straight across   
• Keep the toenails to a moderate length  
• Wear a shoe that fits properly that doesn’t induce extra pressure on the toes  
• Check feet- if you have diabetes there may be signs of ingrown toenails  
• Wear protective footwear such as steeled foot toenails during activities that may cause injuries  

Treatment:¹⁷  

• Your healthcare provider may lift the nail and place a small piece of cotton under the edge of the nail, to separate the grown nail from the skin
• Taping the nail, the health care provider pulls the skin away from the ingrown nail with tape.  
• Placing a gutter splint under the nail. This procedure is slipping a tiny slit tube underneath the embedded nail. The splint stays in place, and thenail will grow above the skin's edge. This method helps ease the pain
• Partially removing the nail. Trimming or removing the ingrown portion of the nail  
• Removing the nail and tissue. If the problem reoccurs in the same toe, your healthcare provider may remove a portion of the nail along with the underlying tissue (nail bed). This procedure can prevent that section of the nail from growing back

Turf toe

Turf toe occurs when there is a sprain in the main big toe joint. This sprain is a metatarsophalangeal (MTP) joint sprain. This sprain occurs due to bending the big toe upwards towards the top of your foot too far. This injury affecting the toe and the ligaments surrounding it, and this can affect the tissue in one or more of the joints which connect to the toes and the rest of the foot. This happens mostly during sporty activities.¹⁸ Turf toe is experienced in 45% of NFL players.¹⁹ 

Symptoms: sensitivity or discomfort around the toe and nearby joint, tenderness, swelling around the big toe and joint, inability to move the toe around, stiffness in the toe joint. 

Causes: 

When the turf toe occurs, the big toe area and the MPT joint, also called the plantar complex, can get injured. The areas that may be affected with Turf Toe are: 

• Sesamoids:  are two small bones that take up the weight of the front of your foot 
• Flexor hallucis brevis: is a tendon that protects the big toe when weight is put on it from jumping and running
• Collateral ligaments: bands of tissue that connect your toe bones and keep the big toe from bending to the side of your foot
• Plantar plate: a structure that keeps your big toe from being bent too far up 
• These injuries are most prone to athletes that put a lot of weight on their big toes of feet due to running or jumping for prolonged periods

Prevention: Wear stiff shoes when playing sports; metal plates in the base of the shoe can prevent the shoes from bending. Exercising your feet, bending toes sensitively, stretching muscles, joints and ligaments in the feet. 

Treatments: Rest, apply ice, wrap or compress a badge around the foot and toes to keep the toes contained;prevents movement; elevate your foot to let the fluid drain and to help keep the swelling down.  

More serious injuries may require crutches or a walking boot. Injuries that cause the bone to break, ligament to tear, or severe joint damage may require surgery to treat and depends on how much the plantar complex is damaged.¹⁸ 

Sesamoiditis

Sesamoiditis is a particular type of tendonitis, which is an inflammation of the tendons. This inflammation occurs in the ball of the foot. The feet contain small sesamoid bones embedded in them. There are also two pea-seized sesamoid bones that are located under the big toe joint; these structures help produce leverage when tendons place weight on the ball of the foot.²⁰ 

Symptoms: Pain under the big toe, trouble bending the big toe, hard to bear weight or walking, swelling, redness, and bruising. 

Causes: The overuse of tendons interacting with sesamoid bones in the foot causes sesamoiditis. Usually, runners, dancers, and athletes are more prone to be at risk of this as they transfer a lot of weight to the ball of the foot.  

Preventions:  

• Wearing comfy shoes! Which allows your feet to move and ones that do not strain the ball of the foot
• Wear custom orthotics, these types of footwear enable a lot of weight to be taken off your feet and deflect pressure away from the big toe joint
• Preventative therapy- following the procedures of resting well, icing the areas, and elevating feet to relieve inflammation

Treatment: Include rest, temporary strapping or taping your feet, ice and elevation, soft tissue therapy, physical therapy, NSAIDs, steroid injections, and surgery. 

Gout

Gout is a type of inflammatory arthritis  targets your joints. This can be very painful and unpleasant. It can occur suddenly overnight. The best way to detect it is through its symptoms. This is caused by a build of uric acid in your uric acid in the blood called hyperuricemia. 

Symptoms: acute or intense pain in the joint, discomfort after the pain subsides, inflammation or swelling of the joint, redness, and heat sensation within the joint.²¹ 

It is best to seek medical help during a Gout flare. 

Second toe pain

Your big toe can have the most pain, but the second toe pain can also occur due to injuries or chronic conditions. The second toe pain can also cause feelings of discomfort and uneasy sensations. ²² 

Second-toe arthritis

Osteoarthritis and rheumatoid arthritis can affect the MTP joint, leading to persistent inflammation of the second toe, which can cause the toes to look like claw toe. 

Morton’s neuroma

Morton’s neuroma is a condition that develops between the 3^rd and 4^th toes. This can lead to developmental pain and also pain in other toes. When a person develops a thickening of tissues around the nerve, which leads to the toes. You may be able to feel this thickening. Symptoms are a burning sensation in the ball of the foot and transfers to the toes; numbness, and pain can worsen depending on your shoes.²³ 

Freiberg’s disease

Freiberg’s disease ( also called avascular necrosis of the 2^nd metatarsal), is a disease that affects the second MPT joint. Healthcare professionals have no idea why this occurs. However, the symptom it presents : the feeling that you are walking on something hard, pain from weight bearing, stiffness, and swellings around the toe.²³ 

Plantar plate injury

A plantar plate injury occurs when one of the strong ligaments under the foot is injured. This is usually caused due to the immense pressure that is placed on the MPT joint. This try of injury can only be diagnosed via a physical examination and further X-rays, and additional imaging.²⁴  

Second toe stress facture 

Fractures to the forefoot are common and occur from a direct blow to the foot. Stress fractures are usually a result of overuse and repetitive stress. Although fracturing your foot or toes can be painful, this usually does not require surgery. ²⁵ 

Second toe stress fracture

Fracture to the forefoot are common and occur from a direct blow to the foot. Stress fractures are usually a result of overuse and repetitive stress. Although fracturing your foot or toes can be painful, this usually does not require surgery.²⁵ 

Diagnosis and treatment

There are different reasons why toe pain may be occurring; therefore, it is important to seek medical help regarding these diagnosis and specific treatments. 

Risk factors

These factors that can all lead to toe pain, such as high-impact sports, weight bearing on foot, and conditions such as arthritis, gout, turf toe, fractures, etc. 

Complications

If your toe pain is a result of minor injuries and medical conditions, this can be easily treatable with medication over the counter. On the other hand, serious conditions such as sesamoiditis may require a healthcare professional to provide clinical treatment.

How to ease toe pain yourself

In summary these are the things you can do to treat toe pain non surgically at home to ease the pain: 

• Ice and Elevation  
• Rest and raise your feet 
• Take painkillers 
• Wear comfortable wide shoes with soft sole 
• Stretch your feet 
• Strapping your broken toe if necessary  

When to see a doctor

If the pain gets better over time, it is not necessary to seek help. Many sprains can heal if given plenty of rest. The Arthritis Foundation suggests contacting a doctor for joint symptoms that do not improve after three days or if several joint symptoms occur within a single month. It is also crucial to contact your doctor if there is severe sudden pain occurs. 

Summary

Toe pain can arise due to various reasons, including chronic conditions, trauma, or pressure from weight build up. In most cases, this is treatable either by nonsurgical methods or surgical options. Commonly, some injuries can heal with rest and pain medication. However, types of arthritis need long-term solutions and input from medical professionals. It is possible to prevent these injuries through lifestyle, healthy eating, gentle exercise, and appropriate footwear. If Toe pain doesn’t resolve over time, please contact your doctor.