Pain in the big toe

Pain in the big toe can have various causes. As a rule, it affects adults and is very rare in children.

This symptom is felt especially when walking and running, but it can also be felt when cycling, because the toe is slightly bent upwards.
The hallux pain occurs just as often on the right as on the left.


Causes of big toe pain

1) Gout
is a metabolic disease that affects the big toe. Gout occurs when uric acid accumulates in the blood.
If the uric acid crystallizes, the crystals are deposited in the joints.
The symptoms of gouty arthritis manifest themselves:

  • In the skin;
  • In the joints.

The skin is red, overheated and painful.
If the attacks of arthritis urica persist and are not treated, they can cause joint damage.

2) Arthritis
Osteoarthritis of the big toe joint is the most common form of arthritis that affects this joint. Osteoarthritis is caused by wear and tear.
The most common symptoms are joint pain and stiffness.

Trauma leading to fracture, dislocation, etc. can favor the formation of osteoarthritis.
Other types of arthritis of the big toe include:

  • rheumatoid arthritis,
  • Psoriatic arthritis.

3) Bruise or trauma
Trauma can lead to a bone lesion or damage to the surrounding soft tissue of the big toe, or even just the formation of a hematoma and inflammation.
One of the consequences that can arise when an object falls on your feet is a black toenail.
After many repeated traumas, the nail can also detach.
In the first 2-3 days after the trauma, the toe should no longer hurt, but playing with a ball can cause discomfort.

4) Hallux valgus
Hallux valgus 
is a common pathological change in humans and it occurs together with inflammation of the bursa or the ball of the joint, which is located on the inside of the joint.
Hallux valgus causes a displacement of the big toe: it bends over time against the second and third toes.
At the bottom of the big toe, a blister (bursitis) forms on the inside, the toe is swollen, reddened and painful.
Most bursitis is caused by a biomechanical problem of the foot.
Rheumatoid arthritis is another disorder that leads to hallux valgus.
Hallux valgus is accompanied by some deformations of the other toes that adapt to the new position of the big toe.

5) Ingrown toenails occur when a sharp corner of the nail penetrates the surrounding tissue.
An ingrown nail can be painful and cause infection.

6) A sprain of the big toe is often caused by sports activities.
It means a strain of the tendons and ligaments, which can happen quickly when running or jumping.
With this pathology, the launching pain and swelling pass in a few days.

7) Corns and calluses Corns
and calluses 
consist of dead cells formed by pressure and friction; they cause pain and discomfort (Landorf et al. – 2013).

8) Fungal infection
Fungi thrive in warm and humid areas such as locker rooms of sports clubs and showers in gyms.
Mushrooms can be found in beauty salons that do not comply with the appropriate hygienic conditions in manicure and pedicure.
If a microorganism gets under the toenails, it finds a suitable place to survive there.

The circulation is a mycosis (fungal infection) that occurs on toenails and fingernails and is caused by bacteria or fungi (for example, candida).
Symptoms include pain, swelling and redness at the base and sides of the nails. In severe cases, vesicles are formed, which are filled with pus (abscess).

9) Stiff big toe (hallux rigidus)

Foot arthritis often manifests itself at the big toe joint (MTP joint). This joint is located between the first metatarsal bone (metatarsal) and the proximal toe limb (phalanx proximalis) (Lam et al. – 2017).
This joint must bend with every step.
If the joint is stiffened, walking becomes painful and difficult.
In the MTP joint, the bone ends are covered by articular cartilage.
If the cartilage is damaged by wear, the ends of the bones may touch.
The bone surface is damaged and deforms.
This can lead to excessive bone growth (Shurnas – 2009).
This excessively increased bone tissue can cause joint stiffness: the tip of the toe no longer bends when walking.
Hallux rigidus forms in adults or the elderly, the symptoms worsen with weather changes and cold weather.

The disease is caused by repeated stress on the joints of the big toe.
Trauma to the tip of the toe can lead to hallux rigidus (Deland et al. – 2012).
Sometimes a disease such as gout can promote stiffness.


  • pain when walking (John MM et al. – 2011),
  • Swollen big toe (Kon Kam King et al. – 2017),
  • Bale on the forefoot
  • Stiffness during upward and downward movements of the toe

10) Fracture of the big toe

Often trauma to the toes causes fractures, for example:

  • The fall of a heavy object on the toe.
  • A kick to the ground or tripping on uneven terrain.
  • A toe can also break under repeated and prolonged stress.
    This type of injury is called fatigue fracture.

Symptoms of a toe fracture
After the trauma, pain, swelling, blue discoloration and stiffness appear.
If the fracture is displaced, it appears in an unnatural position.
The bone can pierce the skin.
Walking is very difficult because it is extremely painful.
It can hurt when you put the shoe on.
Complications occur immediately after the injury (after minutes and days) or much later (after weeks and years).

Immediate complications
Hematoma: Under the toenail, a collection of blood develops, also called a subungual hematoma.
If the hematoma is large, the doctor must suck it off.
To drain the subungual hematoma, the doctor makes a small opening in the nail. If the blood accumulation hurts or is very extensive, the doctor may remove the entire toenail.
Dislocated fracture: Rarely, the broken bone penetrates through the skin. The surgeon cleans the wound and prescribes an antibiotic to prevent bone infection.

Late complications
After the toe has healed, the individual may suffer from arthritis, pain, stiffness or joint deformity.
Rarely, a broken bone heals incompletely. Surgery can solve this problem.
The therapy consists of immobilization and sometimes surgery if the fracture is dislocated and unstable.
In any case, magnetic therapy is recommended to shorten the healing time.
As soon as possible, rehabilitation and some light activities such as cycling take place.

Pain under the big toe

The two inflammatory diseases are sesamoiditis and gout, rarely tendonitis of the long big toe flexor (flexor hallucis longus) develops.
Sesamoiditis is an inflammation of the sesamoid bone.
The sesamoid bones are two small round bones between the big toe and the first metatarsal bone.
Impression, anti-inflammatories, and an insole (Cohen – 2009) can reduce pain.
Gout exists when there is a high concentration of uric acid, which is deposited in the joints.
These deposits are present in all body joints, including the big toe.
Drinking plenty of water and painkillers and corticosteroids reduce swelling and pain (Tausche et al. – 2009).

Nocturnal pain on the big toe

Symptoms of peripheral neuropathy vary depending on the type of neuropathy. Early symptoms include:

  • Numbness
  • ant tingling,
  • Foot pain.

The pain on the big toe is pulsating and causes a feeling of burning.
Peripheral neuropathy can cause pain in the big toe.
Diabetogenic neuropathy is the most common form.
These symptoms occur mainly at night (Schreiber et al. – 2015) and run from the foot upwards to the leg.
Treatment depends on the underlying disease.
Diabetics need to control blood sugar levels.
Pay attention to a balanced and vitamin-rich diet.

Tarsal tunnel syndrome
Tarsal tunnel syndrome is caused by compression of the tibial nerve (tibial nerve).
The tarsal tunnel is a narrow canal located on the inside of the ankle joint below the inner ankle.
Compression of the tibial nerve in this canal causes:

  • Numbness
  • Tingling ants (Olivier Fantino – 2014),
  • Swelling
  • Burn
  • Pain along the nerve course, from the inside of the heel to the tips of the toes (Bouysset et al. – 2012).

During the night, symptoms worsen.

The doctor prescribes painkillers and NSAIDs (non-steroidal anti-inflammatory drugs) to reduce pain and inflammation.
Some patients require cortisone injections.
Physiotherapy and the use of a support bandage can be helpful.
Ice compresses are a home remedy for pain relief.
The footwear is crucial. The shoes must not be too tight and should have a heel of at least 1 cm. Flip-flops are therefore not recommended.
Other remedies are arnica ointment or devil’s claw.

Surgical intervention is required when a nerve is pinched (Ahmad et al. – 2012).

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