There may be a number of causes for pain in your big toe. Turf toe is a name given to a sprain of the joint at the base of your first toe. Hallux limitus (stiffness of the first metatarsalphalangeal joint), as its name suggests, is a condition that causes limited movement at this toe, as well as pain. Bunions, as they are known colloquially, is a condition where the first toe progressively deviates and begins to point toward the second toe (sometimes overlapping it). Another cause of big toe pain is gout, an inflammatory arthritis that leads to joint pain, swelling and redness.
Tell me more about these conditions
Turf toe is a name given to a sprain of the joint at the base of your first toe (first metatarsophalangeal). It is caused by an injury such as hyperextension or stubbing of the big toe. This leads to pain around the big toe joint, with associated swelling and sometimes bruising. In more severe cases, the plantar plate that stabilises the joint on the underside of the foot may be torn.
Hallux limitus (stiffness of the first metatarsalphalangeal joint), as its name suggests, is a condition that causes limited movement at this toe, as well as pain. The progressive stiffness can lead to arthritis and the development of small bone spurs that limit joint movement. In later stages, the condition is sometimes called hallux rigidus. Movement at the big toe is very important for walking, and stiffness can affect the way you walk.
Hallux valgus, or bunions as they are known colloquially, is a condition where the first toe progressively deviates and begins to point toward the second toe (sometimes overlapping it). This leads to a bony prominence at the inside of the first toe joint, and is associated with pain and sometimes limited joint movement and problems with walking.
Another cause of big toe pain is gout, an inflammatory arthritis that leads to joint pain, swelling and redness. Unlike other types of inflammatory arthritis, gout often will only affect one joint at a time of ‘attack.’ The big toe is a common site of gout and is not usually preceded by an injury. Gout attacks are often recurrent.
What causes big toe pain?
Turf toe is caused by a hyperextension or hyperflexion of the big toe. Playing on artificial turf and wearing soft footwear may increase the risk.
Hallux limitus may occur as a result of previous trauma (such as a turf toe injury) or previous high big toe loads. It may also be related to general inflammatory arthritis or osteoarthritis.
Hallux valgus is up to 10 times more prevalent in women. It has been associated with wearing pointed or narrow footwear (such as high heels). It is also associated with a congenital deformity (birth defect) or laxity of the big toe joint, and an excessively flat (pronated) foot.
How do I know if I have a condition of the big toe?
All of the conditions listed above typically present with pain at the joint of the big toe, often with limited movement that affects walking. Hallux limitus and valgus are more progressive, longer-term conditions and typically (though not always) affect older people. Turf toe, on the other hand, is the result of an acute injury, and is seen more commonly in sporting situations. Your physiotherapist will be able to diagnose the cause of your big toe pain. They will assess the movement at your big toe and around the foot. In some cases, if a fracture or other diseases are suspected (such as gout or other types of arthritis), they may refer you to a GP for investigation and treatment.
How can physiotherapy help with conditions of the big toe?
Your physiotherapist will attempt to settle pain and inflammation in the early stages of the injury by advising to ice and offload the foot. You may speak with a GP or pharmacist about whether taking anti-inflammatory medications may be appropriate for you. In more severe cases, the injury may need to be X-rayed and you may need to immobilise the foot or use crutches for a period of time. In milder cases, taping of the big toe may be useful to help you return to your desired activity.
The goal of physiotherapy for this condition is to improve the range of movement at the big toe and to improve affected function, such as walking. Treatment may consist of joint mobilisation of the big toe and other joints of the foot. You may also be given stretching exercises at home, and also exercises to strengthen muscles around the foot. Assessment of footwear and prescription of an orthotic may also be considered. In more severe cases, surgery may be required.
Management of hallux valgus should consist of careful assessment of footwear. Modifications to footwear, by prescribing an orthotic or using different shoes altogether, may be necessary. Taping techniques or toe spacers may provide symptom relief. Your physiotherapist can prescribe strengthening exercises for the foot muscles. Medications may be considered to help settle any acute pain. In severe cases, surgery may be required. It is also important to assess and treat any issues with foot movement during walking motion.
For gout and other inflammatory conditions of the big toe, physiotherapy is not first-line management.
How effective is physiotherapy for conditions of the big toe?
There is a lack of high-quality research investigating big toe conditions. A Cochrane Review showed that physiotherapy treatment (consisting of mobilisation, stretching and exercises) is effective at improving pain in people with osteoarthritis of the big toe joint. Another Cochrane Review found that custom orthoses for hallux valgus reduced foot pain in the short-term, but surgery was superior in the long-term.
What can I do at home?
For turf toe injuries, management of acute swelling and pain will be most important. You may be advised to avoid weight-bearing on the foot, or use crutches or a walking boot in severe cases. For hallux valgus or limitus, your physiotherapist may prescribe mobilising exercises to improve the movement of the big toe. They may also give you strengthening for your foot and lower leg.
How long until I feel better?
For turf toe injuries, return to activity depends on the severity of injury. Minor injuries will be able to return to weight-bearing activities and sport within a week. More severe injuries may take up to three months. As hallux valgus and limitus are more progressive conditions, it is much more difficult to set time frames, and you may be unable to regain full movement and function of the big toe.