The big toe joint, known as the 1st metatarsophalangeal joint is the hardest working joint in the lower limb. Up to 8 x your body weight will be transmitted through the ball of the foot every single step! With so much load it’s pretty easy for us to see how it can lead to foot pain. One of the most common presentations to us podiatrists is big toe pain which can be diagnosed as a few different conditions depending on what part of the joint hurts the most.
Diagnosis can be:
- 1st MTPJ capsulitis (turf toe)
- 1st MTPJ synovitis
- 1st MTPJ osteoarthritis
- HAV, Hallux Valgus (a bunion)
- Hallux Rigidus (a form of arthritis)
- And many more disease pathologies relating to arthropathy, gout etc.
So considering the big toe joint is such a hard worker, and often gets sore, here’s 3 treatment options you can immediately implement to reduce big toe pain and it’s effect on the foot and ankle.
Shoes for big toe pain
We’re not just talking fit here. If you haven’t got a perfectly fitting shoe (length, width and depth) then get that sorted straight away. We know that when you wear shoes, your big toe pain can be increased or decreased depending on the shoe chosen.
With the big toe joint, the midsole and outsole material can have a huge influence on the load going through the 1st MTPJ. Two features of shoes which will immediately reduce the peak (greatest) demands of the 1st MTPJ are;
- A rocker sole
- A stiff forefoot plate – usually made from carbon fibre
A rocker sole can be found on athletic shoes like the Hoka range, with some having more rocker, and others less. Getting one of these shoes fitted nicely and on your foot will immediately reduce the work your big toe is doing. Happy days.
A stiff forefoot plate will also prevent the 1st MTPJ from moving up and down as much. These are built into certain athletic shoes like some of the Nike range (the recent Nike Alphafly used by Eliud Kipchoge to break the 2 hour marathon barrier has 3 carbon fibre plates) and a few others.
Strapping for big toe pain
Sports tape or rigid strapping tape can be a lifesaver for those with big toe pain. You can use the tape to limit movement in any direction to settle a painful 1st MTPJ. The simplest application is to apply some tape above and below the joint as anchors. Next, join the two anchors to each other with some more tape moving the toe in the direction of the tape being applied.
As you can see above, the first step of strapping the big toe is to apply anchor pieces of tape just above and below the 1st MTPJ margin. The second step is to start at the distal anchor (the one on the toe) and then stick the tape down along the toe until you reach the proximal anchor (the one on the foot). When you do this you need to gently move the toe towards the direction the tape is being applied. For example, for the top piece of tape, bend the toe up slightly. For the bottom piece of tape, bend it down a little. Repeat this with 3 – 4 pieces of tape until the joint is covered completely.
Applying strapping tape to the big toe joint like this will immediately limit the amount of work done by the toe, and your pain will decrease.
Orthotics for big toe pain
Orthotics are amazing devices that you can use to manipulate the load on the foot. You can move pressure and forces from sore areas onto not-sore areas. A podiatrist is the best person to see to assess what your exact needs are and what type of orthotic will work best for you.
A prefabricated foot orthotic can often be used to reduce pain at the 1st MTPJ by applying a force directly under the joint just before the big toe joint. This is a nifty way of limiting movement in the 1st MTPJ without increase the pressure underneath the joint.
A custom orthotic can also be used to much more specifically reduce the load on the big toe. By varying the geometry of the device you can increase the work done by other toes and joints like the midfoot or the ankle.
When writing this piece I wanted to show just what an amazing, hard working and overlooked joint the 1st MTPJ is. It’s no surprise to any podiatrist when someone walks (or limps) into our clinics with a sore big toe, they work so damn hard! Think of all the people you know with hip or knee replacements? We can’t really replace the big toe joint and yet many times more force goes through it than the hip and the knee combined.
So the great news that three simple things can be done to immediately reduce pain at the 1st MTPJ. Shoes, strapping and orthotics.
There are many more things you can do including appropriate exercise and physical therapy, strengthening and other symptom modifiers which your podiatrist can prescribe for you after a consultation to determine what will work best for you.