Big toe pain is one of the most common reasons for someone to come to us podiatrists. And it’s no surprise, 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 to see how it can lead to foot pain .
There’s a whole heap of different types of injury that can cause big toe pain. The 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)
- Big toe sprain
- And many more disease pathologies relating to arthritis, gout and acute injuries that cause a broken bone or compound fracture to the big toe.
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. And improve your quality of life.
Shoes for big toe pain
We’re not just talking fit here. But 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
First let me talk you through the rocker sole. These curved or scooped soles can be found on many athletic shoes. The brand Hoka One One have really brought rocker soles back into style however all major athletic footwear brands have a rocker soled shoe in their range now. In saying that, some have 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 Nike Alphafly is a special shoe used by Eliud Kipchoge to break the 2 hour marathon barrier that has 3 carbon fibre plates.
Strapping for big toe pain
Sports tape or rigid strapping tape can be a lifesaving treatment option for those with big toe pain.
You can use the tape to limit movement in any direction to settle a painful 1st MTPJ. Taping a sprained toe with a large range of motion will give you immediate relief. 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. With this technique we are replicating the connective tissue that would usually stabilise the big toe joint on the inside.
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). This step is important. You must gently move the toe towards the direction that you’re applying your tape. For example, for the top piece of tape, bend the toe up slightly. For the bottom piece of tape, bend it down a little. You’ll need to 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.
First, 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.
You can also use a custom orthotic 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.
If you’d like to learn more check out this short piece on orthotics for ball of foot pain which will show you how an orthotic can (or can’t) help your big toe pain.
Before you go…
When writing this piece I wanted to show just what a 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.
How’s this for great news? Our three simple things can be done to immediately reduce pain at the 1st MTPJ.
There are many more things you can do including appropriate exercise, 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.
If you need to find us, you can book in with our podiatry team online.
Frequently Asked Questions – Big Toe Pain
After more than 11 years in the podiatry game here are some of the most common questions we get about sore big toes.
How can I prevent my tape from bunching up and sticking to itself while I try to apply it?
Practice and taking your time when strapping your big toe. You can prepare the tape strips prior to applying and stick them on a nearby edge of a hard surface so they are less likely to stick to your hands while you’re trying to stick them on your feet.
What is a sprained toe?
A sprained toe is a common injury where the repetitive movements of daily life or running lead to big toe pain. It’s best to see a podiatrist for a diagnosis and treatment plan as a sprain is not an accurate diagnosis and the treatment for the accurate injuries can vary greatly.
As a starting point the advice in this post about strapping and footwear is a good start to implement before you get medical evaluation from your podiatrist.
How to run with a sprained or broken toe??
Running on a broken toe when there is severe pain is not a good idea. Broken bones in the feet take time to heal. They require further immobilisation than shoes and strapping can provide in the short term. If you have a fracture a moon boot or CAM walker is required to heal a broken bone in the big toe.
With a sprained toe it could be safe to run normally and do most of your planned physical activity. As long as you stabilise with strapping tape and have the right shoes. To know if this is right for you make sure you see a podiatrist.
How to check blood flow of a big toe?
If you don’t have enough blood flowing down to your big toe a few serious things can happen. The most serious is that if there is no blood flow at all then the toe can go numb, black and auto amputate. This is a rare occurrence at the best of times, and even rarer as an acute big toe injury. Usually there would be a history of long standing poor circulation from smoking or diabetes.
A much less serious issue with blood flow to the big toe is you can apply tape too tight. This can cause short term poor arterial circulation to your toe. To check the blood flow gently squeeze the tip of your toe after you’ve strapped it. Your toe should go pale as you squeeze. When you release your grip the colour should come back to normal in less than 5 seconds.
Should I use ice on my big toe pain?
The evidence is starting to move away from icing to manage joint pain. We still will recommend ice in the very early acute phase of an injury. You can apply an ice pack to your big toe joint as soon as it happens to numb the pain a little.
If you’re looking after a more chronic condition then you can use ice if you really want to. It something we don’t recommend in place of the strapping, footwear and orthotics interventions.
Should I buddy tape my big toe?
Your big toe is independent from your 2nd toe. While toes 2 – 5 share muscles and nerve roots the muscles and nerves that influence your big toe are independent. By buddy taping you are not really reducing the loading on your big toe to help a joint sprain or turf toe injury at all. Follow the strapping technique above for best results.
I’ve been battling my turf toe injury for months, what should I do?
A turf toe injury can last a long time as the workload on the big toe joint is immense and usually athletes try to play through the pain. When chronic pain from a long standing injury is present it’s important to double and triple down on the interventions to allow healing to occur as effectively as possible.
Follow the turf toe taping techniques your podiatrist has advised. Wear your custom foot orthotics as much as possible. Ensure your recovery footwear has a similar rocker sole to the shoes mentioned above. Trust the healing process.
About the Author
Melbourne podiatrist Tim Mulholland wants you to be able to walk, run or skip again without suffering big toe pain anymore. When no consulting, you’ll find Tim running and testing out the latest runners from all the big brands and cheering on the Mighty Cats.