Big toe pain is often the result of injury or minor underlying medical conditions. Arthritis, fractures, and gout may all cause big toe pain. Most cases of big toe pain are easily treatable with over-the-counter (OTC) remedies. However, some causes, such as sesamoiditis, may require more in-depth clinical treatment.
This article provides more information on common causes of pain in the big toe, along with some of their symptoms and treatments. Big toe pain has a wide range of possible causes. Various conditions cause big toe pain, with some being more serious than others. They include:
1. Arthritis
According to the American Orthopaedic Foot & Ankle Society, hallux rigidus is the most common cause of arthritis pain at the base of the big toe. It affects nearly 1 in 40 people over the age of 50 years and is more prevalent among females than males.
Symptoms
The most common symptom is pain while walking or doing any physical activity that puts pressure on the foot and toe. Other symptoms may include:
- swelling near the joint of the big toe
- a painful bump on top of the joint
- trouble moving the big toe
Treatment
Treatments for hallux rigidus include nonsurgical and surgical options. Nonsurgical treatments may involve:
- icing or heating
- pain relievers
- platelet-rich plasma injections
- wearing different footwear, such as firmer soled shoes
Surgical options may include:
- fusing the joint
- removal of any bone spurs
- joint replacement
- joint resurfacing
2. Ingrown toenail
An ingrown toenail is a common cause of pain or discomfort in the big toe. It can occur if a person cuts their toenail too short or curves it in too far when cutting it. Wearing tight shoes may aggravate or even cause an ingrown toenail.
Symptoms
There are several potential symptoms of an ingrown toenail. According to the American Academy of Orthopaedic Surgeons (AAOS), the symptoms may include:
- a hard, swollen, or tender toe
- soreness
- skin darkening
- pus oozing from the area, in the case of an infection
Treatment
Treatment typically starts with nonsurgical options, but a doctor may perform surgery on persistent ingrown toenails. Nonsurgical treatments may include:
- taking OTC pain relievers, such as ibuprofen or acetaminophen
- soaking the foot in a warm bath three or four times a day
- keeping the foot dry and removing sweaty socks as soon as possible
- wearing breathable, comfortable footwear
Surgical options include:
- partial removal of the nail
- full removal of the nail
- permanent nail removal — often necessary for chronic cases
3. Gout
Gout is a condition in which uric acid builds up in a person’s joints. According to the American College of Foot and Ankle Surgeons (ACFAS), it commonly occurs in the joint of the big toe. The body typically removes uric acid through urine, but in some cases, it may build up and cause crystallization in the joints.
Symptoms
The symptoms of gout include:
- inflammation that causes skin darkening, swelling, or warmth at the joint
- intense pain that occurs in the middle of the night or when a person first wakes up
- shiny skin over the affected joint
Treatment
The ACFAS state that inflammation associated with gout typically clears in 3–10 days. Typical treatments may include:
- drinking plenty of fluids
- elevating the foot
- resting from standing, walking, or other activities
- taking medications to treat inflammation and pain
People with gout should also avoid consuming drinks and foods high in purines, such as alcohol, bacon, liver, and some types of seafood.
4. Turf toe
Turf toe is an injury to the joint of the big toe that occurs during sporting activities.
According to the ACFAS, this injury happens due to repetitively bending the big toe upward or jamming it. Repetitive jumping or running could cause the big toe to bend awkwardly. The condition is more common in athletes who play on artificial turf.
Symptoms
Turf toe is typically the result of repetitive movements. As a result, the pain and swelling will often gradually build up over time. In addition to pain, a person may notice swelling and loss of mobility in the joint.
If a person experiences an acute injury, the pain will come on suddenly and may worsen over the course of 24 hours.
Treatment
Stopping the activity that is aggravating the toe is usually the best course of action. Doing this helps prevent the injury from getting worse. Typically, treatment involves rest, icing, compression, and elevation (RICE).
A doctor may suggest wearing less flexible shoes when playing sports. As a last resort for severe injuries, they might recommend surgery.
5. Sesamoiditis
According to the AAOS, sesamoids are bones that connect to tendons or are embedded in muscles. The kneecap, for example, is the largest sesamoid.
Sesamoiditis occurs when the tendons around the sesamoid below the big toe become inflamed or irritated. This condition is common in runners and ballet dancers.
Symptoms
In addition to pain, symptoms of sesamoiditis may include:
- trouble moving the big toe
- the gradual buildup of pain
- bruising
- swelling
- pain on the ball of the foot
Treatment
There are several potential treatment options for sesamoiditis. Some treatment options that a doctor may recommend include:
- steroid injections
- nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and swelling
- strapping, padding, or taping the toe or foot
- use of custom orthopedic devices
- physical therapy
6. Fracture
Fractures or breaks of the toes are common occurrences. The AAOS note that fractures may occur when a person:
- kicks a hard object
- drops a heavy object on the toe
- repeatedly performs a movement that puts pressure on the toe
Symptoms
Pain and swelling of the toe are two common symptoms, but a person may also notice discoloration around the toe.
Treatment
Treatment options will vary depending on the severity of the toe fracture. In the case of blunt, sudden trauma, the steps that a person could take include:
- avoiding placing weight on the toe
- elevating the foot
- using ice to reduce swelling
- wrapping the toe
A person should discuss further treatment options with their doctor.
7. Bunion
A bunion is a deformity of the joint at the base of the big toe. The joint protrudes outward and creates a visible bump on the side of the foot. This abnormality causes the toe to point in the opposite direction and potentially overlap onto the toe next to it.
Many shoes put pressure on the protruding joint, and, over time, the pressure may cause the fluid filled sac in the joint (bursa) to swell and become inflamed.
Symptoms
A bunion may cause swelling, inflammation, and pain. The big toe also visibly points inward while the joint at its base points outward.
Treatment
To alleviate symptoms, a person should wear shoes that do not put extra pressure on the joint. A wide and flexible sole is ideal.
Some additional treatments may include:
- OTC bunion pads
- nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen
- warm soaks
- icing the joint
- massage
Other causes
Other potential causes of pain in the big toe include:
- nail infections
- Raynaud’s disease
- Morton’s neuroma
- rheumatoid arthritis
Additional symptoms and treatments can vary depending on the exact cause of the pain.
When to see a doctor
In cases of sudden injury or unexplained pain, a person should see their doctor for diagnosis and treatment. A doctor may recommend at-home treatments or other medical interventions that alleviate pain.
Outlook
Many causes of pain in the big toe are treatable. For simple injuries, a person may only need to rest, apply ice, and use pain relievers as necessary.
More serious injuries or medical conditions may require surgery or other medical interventions. In most cases, a person can expect a full recovery if they treat the underlying condition or rest from the activity that caused the injury in the first place.
