Why does your big toe hurt?

Right now, your big toe is hurting more than usual. The big toe can easily become aggravated from walking, running, or exercising due to the weight placed on this joint in addition to excessive inflammation.

The big toe is one of the most important joints in the entire body because it’s involved in helping you walk properly and efficiently; however, it is susceptible to injury due to the repeated strain on this joint with everyday activities like walking or standing.

Perhaps you are still recovering from an old ankle injury or foot surgery. Stiffness and tightness in the ankle can lead to excessive strain on the big toe and impaired function of your foot.

What can you do to reduce big toe pain? We’ll be discussing several factors that may contribute to your pain. By focusing on the factors most relevant to your big toe pain, you’ll be able to manage the pain better and hopefully eliminate your pain completely.

Prevalence of big toe pain.

Big toe or great toe pain is common across all ages. However, an increase in age increases the chances of pain. Also, big toe pain is more common in females than males.

It is also common in athletes. Research suggests that around 10% of injuries presented to fracture clinics are related to the big toe. Severe injuries in athletes, especially in runners may cause loss of function and thus, leads to permanent disability.

Dorsal forefoot showing bunion with loose joint capsule.  SOURCE: 60215A
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Factors contributing to big toe pain.

There are several factors that can potentially influence big toe pain. These factors include:

Age: Females, especially aged 50 years and over, are more susceptible to this pain. The joint can be strained due to weakness and repeated stress through the years.

Occupation: Occupations that involve prolonged standing can play a role in big toe pain. Health care professionals (like nurses), coffee shop baristas, dancers (like Ballet dancers) are examples of these occupations.

High BMI: High BMI places higher pressure on weight-bearing joints which can lead to pain in weight-bearing joints like the big toe. Obesity is also associated with chronic pain due to increased inflammatory markers in the body. Inflammation is also associated with elevated levels of pain.

Footwear: Proper footwear is important for healthy feet. Poor fitting shoes or high heels can place excessive force on the big toe and lead to misshaped feet with repeated use.

Systemic disorders like Diabetes: Diabetes affects the somatosensory system of the body. This includes either altered sensation or loss of sensation. Diabetes also leads to secondary conditions like diabetic foot and diabetic neuropathy. These conditions lead to foot problems including pain.

Medical concept. Foot pain. Body health problem, healthy feet swollen joints or blisters, wounds on skin. Painful barefoot woman at home or office with high heels in the background

Musculoskeletal disorders:

  • Sesamoid fracture: Fracture of the sesamoid bones in the foot can lead to the pain.
  • Turf toe: Injuries of the soft tissues around the first toe may be involved.
  • Sesamoiditis: An overuse injury that causes chronic inflammation of the sesamoid bone. It causes acute or chronic pain around the first toe.
  • Osteoarthritis: Degenerative changes on weight-bearing joints lead to pain and loss of function.
  • Osteoporosis: Decreased density of bones can lead to fragile bones. Fractures are common in people with osteoporosis.
  • Rheumatoid Arthritis: This autoimmune arthritis affects mainly small joints. Rheumatic arthritis commonly causes pain and stiffness around the joints.
  • Gout: Big toe pain is very common in gout. A swollen, red and painful big toe that appears suddenly is a classic sign of gout.
  • Plantar Fasciitis: Plantar fasciitis commonly does not cause pain in the toe. In some instances, however, it is found to be a source of the big toe pain.

What does the big toe do?

The big toe helps to maintain static (stationary) and dynamic (while in motion) body balance. It controls pronation of the foot. This is crucial especially during walking and running.
During walking, the weight is transferred forward and inwards on the foot. The big toe helps to control pronation (falling inwards) of the foot, allowing the body to move forward.

Vector illustration of the normal human foot and the foot with pronation or flatfoot, with hindfoot deformity. Too many toes sign.

What are the treatment options?

To treat this pain, it is important to identify the primary sources of the pain. Treating the actual source can not only reduce the pain and other symptoms, but also prevent the symptoms from recurring.

Here are several options you may get from a doctor:

  • A physician may prescribe medications to relieve pain and inflammation.
  • Antibiotics are prescribed to treat infections.
  • Antifungal medicines or ointments are necessary in cases of fungus.
  • Ingrown toenails are treated by a podiatrist.
  • NSAIDs, steroids, and XOIs (Xanthine Oxidase Inhibitor) are prescribed to treat gout.
  • Surgery is considered in chronic cases. The common surgical interventions are the removal of a bunion, and correction of the tendons and ligaments.
  • In severe cases, removal of the great toe is necessary. The patient has to go through rigorous physical therapy to retrain the foot and other toes.


In other cases, medical treatment of an underlying disease may be a beneficial option. For example, rheumatoid arthritis and diabetes are diseases that may increase pain in the big toe. Managing those conditions can help to control the pain better.

How can physical therapy help reduce big toe pain?

Physical therapy is one of the most beneficial treatment options for big toe pain because it has the potential to help you control the pain without surgery, pain medications, or injections. These are solutions your physical therapist can help you implement:

  • Strength training: Strengthening the muscles in the legs and around the great toe is important to regain function and reduce the chances of recurrent pain.
  • Mobility training: Increasing motion in the ankle joint can help to alleviate strain on the big toe and restore the normal mechanics of your foot.
Adult male physiotherapist treating the foot of a female patient. Patient is sitting on a bed.
  • Movement education: A physical therapist can teach you how to move and control your body better to minimize the ill effects of poor posture and poor body awareness.
  • Proper footwear: Proper footwear is crucial for healthy feet. Footwear recommendations can be provided by your physical therapist.
  • Orthotics or braces for the toes or foot: Braces or orthotics on the foot may help to improve foot alignment while walking thus reducing excessive strain on the big toe. Orthotics can be useful for severe cases of foot pronation or intense pain.
  • Lifestyle changes: Making lifestyle changes are important to manage pain.
    • Weight management: Managing body weight to reduce pain on weight-bearing joints.
    • Arthritis: Managing arthritic symptoms by exercising daily to maintain full range of motion of the foot and ankle.
    • Diabetes management: Changes in diet and regular exercise to keep blood sugar levels under control.
    • Daily foot examination: It is important to check your foot, including the sole of the foot and web spaces once or twice a day. A person should develop a proper hygiene routine to keep the feet and toes healthy.

Don’t let big toe pain stop you from living your life.

Pain in the big toe is extremely frustrating, but you can get better with the guidance of your physical therapist and doctor.

If the pain doesn’t go away after trying to fix the issue on your own, then it is time to schedule a consultation with your doctor or physical therapist.

The solution to your big toe pain may be a simple modification to one of your habits or it may be a problem that requires a more involved intervention.  Either way, there is much hope and optimism to feel better.

Soft focus woman massaging her painful foot while exercising.   Running sport injury and healthcare concept.

In most cases, exercises to strengthen the lower leg and hips will help to restore your pain-free function. These exercises will likely provide you with pain relief now and they will enhance your long-term foot health to minimize the development of bunions and more serious foot problems that may require surgery. 

In addition, a proper exercise program will help to promote a healthy inflammatory response in the body. If you exercise too aggressively, then you may cause more pain by increasing inflammation.

Too much inflammation can cause more pain. The right amount of exercise will promote healing and a better inflammatory response that will improve your healing capacity.

inforgraphic big toe

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