Foot Bone or Joint Injury
Bunion Pain: Differential Diagnosis
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Big toe pain can considerably impact your quality of life as it reduces your mobility, and in some cases, it can be painful to stand as you walk or run. Several conditions can cause pain in the big toe when walking, so conditions affecting the joint are often misdiagnosed. The article will summarise the symptoms, causes and treatment for most of the conditions that cause big toe pain.
Hallux Rigidus – Arthritis
Hallux Rigidus is a degenerative condition that affects the big toe joint (MTP) and causes swelling, pain and inflammation. It is graded from 0-4, with 0 being symptom-free but with a slight loss of dorsiflexion and grade 3-4 if a complete loss of dorsiflexion with constant pain in the joint. Hallux Rigidus is more prevalent in females than males, and you are more likely to get the condition if you have a family history.
High heels, poorly fitted shoes and repetitive impact can cause the condition, while treatment involves Physical Therapy, footwear changes, insoles and, in some cases, an injection. Severe cases of Hallux Rigidus may require surgery.
Related Article: Hallux Rigidus: Symptoms, Diagnosis & Treatment
Bunion
A bunion (Hallux Valgus) is a condition that leads to a deviation of the big toe joint away from the midline and towards the second toe. In cases of a congenital bunion, some patients can have pain-free symptoms for their entire life despite a considerable change in the position of the big toe. However, it can indirectly cause problems elsewhere on foot. Adolescent bunions form during the teenage years, while adult bunions are more common from the age of 60 years. When symptomatic, bunions can be painful when walking, running or jumping with tight–fitting shoes aggravating symptoms significantly.
There is a strong genetic link to developing bunions, with some prevalence studies indicating a 90% likelihood of developing a bunion if you have a family history, especially on your mother’s side.
Treatment for bunions should be with a Physical Therapist or Podiatrist, including strengthening and stretching exercises, insoles, footwear advice and lifestyle education.
Related Article: Best Shoes for Bunions
Gout
Gout is a painful condition that can affect multiple joints in the body but is most commonly seen in the big toe due to inflammatory arthritis. It is most commonly seen in males, although the prevalence in females increases after menopause. Gout occurs from high uric acid levels in the body and can cause severe pain and swelling in the big toe joint, which is constant with an insidious onset.
You are more likely to develop Gout if you have a family history, you are obese, you have high blood pressure or Kidney disease. Lifestyle factors that can cause Gout include diuretics, high consumption of animal meats and high alcohol consumption.
Treatment for Gout includes anti-inflammatories and other medications to reduce uric acid levels, while the focus should be on lifestyle changes to reduce the frequency of flare-ups.
Turf Toe
Turf Toe is an injury to the big toe caused by hyperextension of the 1st MTP joint, and it is a common condition in running sports on hard surfaces. Turf toe can result in pain and swelling around the big toe joint after a slip or a trip where the big one is hyperextended, resulting in a ligament’s sprain to the big toe joint.
Other causes are kneeling, BJJ, football, and wearing high heels, commonly seen in dancers.
Treatment for Turf Toe involves using a Turf Toe Brace or Taping to immobilise the big toe joint, reducing inflammation and protecting the joint. Following protection, strengthening and mobility exercises for the foot and ankle can reduce the risk of recurrence.
Related Article: Turf Toe Braces
Sesamoiditis
Sesamoid bones are floating bones that sit within a tendon. The patella bone is the most well-known sesamoid bone, and two small sesamoid bones sit underneath the big toe joint. One of the main functions of a sesamoid bone is to work as a pulley, allowing more force to be applied to a tendon than a tendon can handle without a sesamoid. However, if the sesamoid becomes overloaded through a sudden increase of use or repetitive overload, it can become inflamed, leading to Sesamoiditis.
As well as an overload, high heels, jumping sports, hypermobility, ballet, dancing and gymnastics can cause Sesamoiditis.
Treatment for Sesamoiditis includes immediate rest, anti-inflammatories, icing and cushioned shoes. A gait analysis can identify biomechanical causes of the condition while strengthening and balance exercises, footwear and insoles can help address the identified imbalances.
Related Article: Sesamoiditis: Symptoms, Diagnosis & Treatment
Other causes of Big Toe Pain include:
- Fracture
- Ingrown Toe Nail
Physiotherapy with James McCormack
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.
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