Pain in the big toe can have a variety of causes; a fundamental distinction must be made between those that originate in the big toe or the metatarsophalangeal joint of the big toe, and internal diseases in which joint pain is one of the symptoms. Diseases or injuries affecting the joint are a common cause of pain in the big toe. The joint that connects the big toe to the metatarsus, called the metatarsophalangeal joint, is essential for the rolling motion of the toe when walking, and therefore, the disease and pain are often experienced as extremely restrictive and uncomfortable.
Gout in particular is a major cause of complaints affecting the metatarsophalangeal joint of the big toe. The metatarsophalangeal joint of the big toe is a ball joint that connects the bones of the metatarsus with the big toe. If this joint is affected by gout, it can cause considerable pain.
Other diseases can also cause pain in the joint. Arthrosis in the joint, also known as hallux rigidus, is another common cause of pain in this area. Injuries and broken bones can also significantly affect the joint of the big toe. In this case, it is particularly important during therapy to ensure that there are no malpositions so that after the fracture has healed, no permanent damage occurs that could affect the gait pattern.
Possible causes
A fracture (fracture) of one of the two big toe limbs is usually the result of a direct violent impact; this occurs either when a heavy object falls on the toe or when the toe hits a fixed edge. Surprisingly, the base phalanx (the phalanx connected to the metatarsus) breaks much more frequently than the terminal phalanx. A distinction can be made between a smooth fracture and a splinter fracture.
Signs of a fracture are severe pain in the corresponding area, especially when the big toe is touched or moved. In addition, there is often swelling and bruising may occur (see: Bruising under the nail). Since the tendons of the muscles responsible for the movement of the big toe are attached to the limbs of the big toe, the pulling of the tendons on the bone fragments often leads to toe malpositioning in the event of a fracture, which is also a clear indication of a toe fracture.
The most common toe malalignment, hallux valgus, is a combination of internal rotation (inward rotation) of the big toe and a deviation of the metatarsophalangeal joint of the big toe medially (towards the other foot). It is often associated with a splayfoot. Hallux valgus usually causes hardly any discomfort – apart from the cosmetic aspect.
If a patient with hallux valgus again suffers from pain in the big toe, then at first mostly only under stress; at rest, the patient is pain-free. It is only at a late stage that permanent pain develops even at rest, resulting from the subsequent damage. The malalignment gradually leads to the formation of exophytes (bony extensions) on the first metatarsal bone, which is connected to the metatarsophalangeal joint of the big toe.
This is accompanied by irritation of the bursa in the metatarsophalangeal joint of the big toe due to the constant friction on the shoe. This is increasingly painful and can initially manifest itself in the form of a swelling, later also in the form of a slight inflammatory reaction (redness, swelling, overheating). Another consequence of the incorrect weight bearing resulting from a hallux valgus can be a hallux rigidus (an arthrosis in the metatarsophalangeal joint of the big toe).
In addition, the symptoms trigger a change in the patient’s gait pattern; the steps become shorter. Due to the “displacement” by the big toe, complaints can also occur in the other toes and metatarsals. The development of corns at the pressure points of the metatarsophalangeal joint of the big toe can also be promoted by a hallux valgus.
Based on the causal, characteristic malpositioning of the big toe, hallux valgus can be clearly distinguished from other possible causes of pain in the big toe. The diagnosis is mainly made by external inspection. However, especially for the assessment of the joint condition with regard to the formation of exophytes and arthrosis (hallux rigidus), apparative procedures (especially x-rays) can also be used.
Hallux rigidus is an arthrosis in the metatarsophalangeal joint of the big toe, which can be the result of a hallux valgus or gout disease. Hallux rigidus is usually unilateral, affects men significantly more often than women and usually begins in adolescence. The leading symptom is pain combined with a restriction of movement in the metatarsophalangeal joint of the big toe.This limitation mainly refers to the ability of the joint to stretch in the direction of the back of the foot, which is essential for the rolling of the foot and thus for a round, harmonious gait pattern.
In the further course of time, the joint may even stiffen. The result is gait problems that manifest themselves in a limping gait, which can also involve rolling over the outer edge of the foot to relieve the pressure on the inner edge of the big toe. Standing on your toes or even walking on tiptoe is no longer possible or only possible with severe pain.
In addition to pain and restricted movement, a swelling of the joint becomes apparent, often accompanied by redness and overheating. A hallux rigidus is diagnosed primarily by means of an x-ray, which shows the typical signs of arthrosis, e.g. a narrowing of the joint space. Gout (medical term: uricopathy) is a disease in which an elevated uric acid level in the blood leads to the deposition of uric acid crystals in joints and resulting discomfort.
It occurs with conspicuous accumulation in combination with components of the “metabolic syndrome” – obesity, diabetes, hyperlipidemia (fat metabolism disorders) and high blood pressure. Gout is caused in some patients by an increased attack of uric acid and in others by a disturbed excretion of uric acid. Gout often manifests itself first in the form of a sudden attack on a single joint (monarthritis) that lasts for hours or even days and occurs mainly at night.
Half of those who suffer from gout are affected in the metatarsophalangeal joint of the big toe. The affected joint shows the classic signs of inflammation: Especially if injuries and overstrain can be excluded as the cause of these symptoms, gout is very likely to be the cause. Since gout occurs in relapses, the symptoms are not permanent but regress until they reoccur with the next relapse.
It is typical for gout that initially only one joint is affected until, after a longer period of illness, the symptoms also appear in other joints. In the further course of an untreated gout, more and more joints are affected and chronic joint damage can occur. Non-specific symptoms such as fever or chills can also occur.
Another typical sign of gout disease is the so-called gout tophi. These are whitish nodules that lie directly under the skin – mainly from the auricle, hands and feet – and can also break open. Another possible consequence of gouty arthritis is renal insufficiency caused by the deposition of uric acid crystals in the kidney.
- Redness
- Swelling
- Pain
- Overheating and
- Function restriction.
The diagnosis of gouty arthritis is based on a few typical clinical manifestations, which also distinguish gouty arthritis well from the other possible causes of pain in the big toe. Thus, according to the guidelines of the German Rheumatological Society, the physician can classify the diagnosis of gout as probable if the following three points are given Finally, various laboratory tests are used to confirm the diagnosis. In almost all cases, the cause for the development of gout is a functional disorder of the kidney.
This can have various causes, but usually develops due to other diseases such as diabetes mellitus, alcohol dependency or other metabolic diseases.
- The complaints have occurred in attacks,
- They disappear again after one to two weeks and
- Initially only referred to a single joint.
The big toe and its joints are surrounded by a number of tendons that restrict the joints in their movement and thus give the toe the necessary stability. However, these tendons can be the cause of severe pain.
The tendons can cause discomfort, especially if they are overstressed or incorrectly loaded. Especially the tendon of a muscle responsible for bending the big toe can be affected by a so-called tendon inflammation. This is not an inflammation caused by bacteria, but merely caused by overloading the tendon.
Mostly younger people with a typical risk profile are affected. For example, soccer players and ballet dancers are often affected by the disease. Symptoms of such an inflammation are severe pain in the big toe during movements as well as a limited ability to bend the big toe.
An acute inflammation of the tendon can develop into a chronic disease that requires therapy.In addition to conservative therapies with analgesic and anti-inflammatory drugs, surgery on the tendon and adjacent structures can also provide relief. Nail bed inflammation is a bacterial infection of the skin covered by the nail (nail bed). It can be divided into acute and chronic forms.
Acute nail bed inflammation shows the typical signs of inflammation – redness, swelling, overheating and pain. Pus is also often formed as an expression of the inflammatory reaction. The signs of inflammation occur in a characteristic sequence: Initial redness is followed by swelling and redness.
Only as a result of the swelling does pain occur, which is often described as pulsating, since it occurs synchronously with the pulse beat in the small blood vessels of the nail. Itching can also often be associated with the above-mentioned symptoms. In particularly severe, rare cases, acute nail bed inflammation can also cause fever and swelling of the lymph nodes.
Chronic nail bed inflammation is less strongly associated with the typical signs of inflammation, which means that it is often noticed only late. Here, usually only a reddish to bluish discoloration of the nail is apparent. Another difference to the acute form is the occurrence on several nails simultaneously.
