How To Fix Big Toe Joint Pain

Do you have pain in the big toe?

If you do – it is very likely that you are experiencing pain in the joint at the base of the big toe.

This region is referred to as the 1st Metatarsophalangeal (MTP) joint.

This blog post contains a comprehensive list of the exercises and stretches that will help address big toe joint pain.

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Causes

… Why does the big toe joint hurt?

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If there is an excessive amount of pressure placed onto the big toe, this can often lead to irritation of the joint.

The development of pain is usually related to how the big toe interacts with the ground as you walk, run and/or jump. (But can also occur when kicking/jamming the big toe against something!)

If the big toe does not maintain its optimal alignment during movement, the joint may experience difficulty tolerating load efficiently and result in an injury.

Symptoms

The following are the most common symptoms that are experienced with big toe joint pain.

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• Sharp and stabbing pain
• Swelling and/or redness around the base of the big toe
• Big toe stiffness
• Pain while walking or running
• Altered gait pattern

Diagnosis

Here are 2 ways to determine if there is an issue with the joint of the big toe.

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a) Tenderness Along The Joint Line

Instructions:

• Press firmly all around the joint line of the big toe.
• Is there any pain when pressure is applied?

Results: If there is tenderness along the joint line, this suggests that there may be an issue involving the joint.

b) Investigative Scans

Scans such as X-rays, MRI and CT can be used to determine the structural integrity of the joint.

(To obtain a scan, you will need to obtain a referral for your Primary Care Provider.)

Differential Diagnosis

If you have pain in the big toe joint, it is likely that it is related to one of the following conditions.

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a) Arthritis: Degeneration of the 1st Metatarsophalangeal joint.
b) Bunion: Deviation of the big toe leading to a formation a bump.
c) Gout: Build up of uric acid crystals within the joint.
d) Trauma: Usually caused by kicking/stubbing/jamming the big toe against something.
e) Turf Toe: Sprain of the big toe joint due to Hyperextension of the joint.
f) Sesamoiditis: Inflammation of the bones underneath the big toe.
g) Hallux Rigidus: Stiffness in the big toe.
a) Flexor Hallucis Longus Tendon Strain: This tendon is located underneath the big toe and can get injured as well.

Note: Despite having multiple issues that are potentially associated with pain in the big toe, the exercises that will be recommended on this blog post can help with ALL of the conditions listed above.

Why big toe Joint pain Should be addressed as soon as possible:

Even though the big toe is only a small structure of the body, it has a significant influence on how the entire leg moves. (… especially while walking!)

If there is any pain in the big toe, the body will develop compensations in the way the body moves in attempt to avoid making the pain worse.

This can be problematic!

These compensations may eventually lead to a cascade of other issues in the entire body.

Main compensations when walking:

• Limping (Antalgic gait)
• Decreased weight bear on injured side
• Minimal big toe extension
• Toes pointing outwards
• Walking on the outside border of the foot
• Over use of Hip Abductors/External Rotators

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Exercises to fix Big Toe Joint Pain

The following exercises are designed to be pain-free and gentle.

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How do I get rid of pain in my Big Toe joint?

Follow these steps:

1. Minimize Exposure To Aggravating Activities
2. Reduce Inflammation
3. Perform Pain-Free Movements
4. Joint Traction
5. Joint Mobilization
6. Releases
7. Stretches
8. Strengthening Exercises
9. Gait Re-Training
10. Advanced Exercises
11. Side Movements
12. Address Foot Posture
13. Other Things To Consider
14. Surgery

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STEP 1: Minimize exposure to aggravating activities

The first step in addressing the joint pain in your big toe is to identify those movements, positions and/or activities that specifically make your symptoms worse.

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Once you know exactly what makes your pain worse, you will need to either:

• Completely avoid doing it,
• Reduce exposure to it or
• Modify how you perform it.

Activities such as walking, running and jumping tend to aggravate the big toe.

Note: You do not want to remain completely inactive as this can result in deconditioning in the body. The aim is to keep as active as possible without making your symptoms worse.

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Pain while walking

If you experience pain in the big toe while walking, it is likely that you will need to temporarily adjust your walking pattern to reduce the risk of making your pain worse.

It is important that you minimize the amount of pressure on your big toe as you push off the ground.

Consider the following:

• Use a walking aid (eg. crutches, walking stick) for a short period of time. (Just make sure that you do not become dependent on it!)
• Avoid placing too much body weight through the front of your foot. Instead of pushing your big toe into the ground as you walk forwards, consider lifting your whole foot off the ground.
• Avoid walking on uneven ground and hills.
• Take shorter walks.
• Walk slower.
• Use a Rocker bottom shoe.

STEP 2: Reduce Inflammation

You will need to reduce the amount of inflammation in the big toe joint so that you can perform exercises without aggravating your symptoms.

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a) Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

It is recommended that you take an anti-inflammatory medication consistently for at least 7-10 days.

Keep in mind – there are different strengths of NSAIDs and is best used if the prescribed medication is appropriate to the severity of pain and/or amount of inflammation.

(Note: Please consult your Primary Care Provider before taking any medication.)

b) Anti-Inflammatory Creams

Anti-Inflammatory creams can help reduce inflammation in the specific area that it is applied to.

Apply the cream to the big toe joint line for at least 2-3 times per day.

c) Natural Remedies

If you would like to consider a more natural approach, some people report improvements with the use of natural products such as Turmeric, Ginger and Fish Oil.

d) Ice Pack

Apply an ice pack to your big toe for 10-15 minutes.

Do this 3-5 times per day.

(Warning: Make sure that you do not apply the ice pack directly on the skin as you can get an ice burn.)

e) Corticosteroid Injection

This particular injection consists of a steroid (cortisone) and an analgesic substance.

The aim of the injection is to reduce inflammation and pain.

Although cortisone is effective at reducing inflammation, I suggest that you try all of the other recommendations first before considering the injection.

In my opinion – it should not be the first thing that you try.

STEP 3: Pain-Free Movements of the big toe

Even in the early stages of rehabilitation, it is important to maintain the normal movements of the big toe.

This will help prevent the development of stiffness in the joint.

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a) Passive Movements

Instructions:

• Sit down on a chair.
• Place your ankle on top of your other knee.
• Hold onto the big toe.
• Keep your foot completely relaxed throughout this exercise.
• Move your big toe:
  • Up and Down
  • Side to Side
  • In circular motions
• Repeat 20 times in each direction.
• Make sure that you are NOT moving into any pain.

STEP 4: Joint Traction

The following traction technique will help create more space between the bones of the big toe.

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a) Traction of the 1st MTP Joint

Instructions:

• Sit down on a chair.
• Place your ankle onto your other knee.
• Hold onto the base of the big toe.
• Keep your foot completely relaxed.
• Pull your big toe away from the rest of the foot.
• Aim to feel a gentle pulling sensation.
• Hold for 10 seconds.
• Repeat 3-5 times.

Note: Your big toe may get a big crack from performing this exercise. This is due to a release of pressure within the joint.

STEP 5: Joint Mobilization

This mobilization technique will help loosen up the tight joints in the big toe.

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a) Big Toe Joint Mobilization

Instructions:

• Sit down on a chair.
• Place your ankle on the other knee.
• With one hand, firmly grasp the mid foot.
• Use the other hand to hold onto the base of the big toe.
• Apply a traction force by gently pulling the big toe away from the rest of the foot.
• Make sure to keep your foot completely relaxed.
• Whilst maintaining the pull, proceed to move the big toe in an up/down motion.
• Continue for 30 seconds.

STEP 6: Releases

Releasing the tight structures around the big toe can reduce the amount of compression in the big toe joint.

(Note: You may need to look up the exact location of the muscles listed below if you are unsure of where they are located.)

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a) Ball Release

(Muscles targeted: Flexor Hallucis Longus/Brevis, Abductor Hallucis, Adductor Hallucis)

Instructions:

• (You will need a massage ball for this exercise.)
• Place your foot on top of a massage ball.
• Apply a firm amount of your body weight on top of the ball.
• Make sure to cover the general region underneath the base of the big toe.
• Continue for 30 seconds.

b) Extensor Hallucis Longus Release

Instructions:

• Sit down on a chair.
• Place your foot on top of the other knee.
• Place your thumbs on top of the Extensor Hallucis Longus.
• Apply a firm downward pressure and glide towards the big toe.
• Repeat for 10 strokes.

c) Capsule/Ligament/Joint line

Instructions:

• Sit down on a chair.
• Place your foot on top of the other knee.
• Using your thumbs and pointer fingers, apply a firm amount pressure around the circumference of the big toe joint.
• You can use a circular motion with your fingers.
• Continue for 1 minute.

STEP 7: Stretches

Stretching tight muscles around the big toe will help reduce tension and compression in the region.

Note: Aim to move your big toe at different angles to ensure that you can feel the specific stretch.

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a) Big Toe Flexion

(Muscle targeted: Extensor Hallucis Longus/Brevis)

Instructions:

• Place your foot on top of your other knee.
• Have your foot in a pointed position. (Plantarflexion)
• Pull the big toe downwards into flexion.
• Aim to feel a stretch on top of the base of the big toe.
• Hold for 30 seconds.

b) Big Toe Extension

(Muscles targeted: Flexor Hallucis Longus/Brevis )

Instructions:

• Sit down on a chair.
• Place your ankle on top of the other knee.
• Hold onto the heel and underneath the forefoot.
• Pull your foot backwards. (Dorsiflexion)
• Pull your big toe backwards.
• Aim to feel to stretch in the medial arch of the foot.
• Hold for 30 seconds.

c) Big Toe Extension (Against Wall)

Instructions:

• Place the undersurface of the big toe onto the corner of the wall.
• Aim to get the foot as close to the wall as possible.
• Lean your foot firmly into the wall.
• Aim to feel a stretch underneath the big toe.
• Hold for 30 seconds.
• Note: Do not force this stretch if you start to feel pain at the top of the big toe base.

d) Big Toe Extension (Advanced Stretch)

Instructions:

• Kneel down on the floor.
• Make sure that the toes are completely bent backwards.
• Shift your body weight on top of your toes and forefoot.
• Aim to feel a stretch under the foot.
• Hold for 30 seconds.
• Note: Do not force this stretch if you start to feel pain at the top of the big toe base.

e) Abduction

(Muscle targeted: Adductor Hallucis)

Instructions:

• Sit down on a chair.
• Place your ankle on top of the other knee.
• Hold onto the middle of the foot.
• Pull the big toe towards the outside.
• Aim to feel a stretch on the inside of the big toe.
• Hold for 30 seconds.

STEP 8: Big Toe Strengthening Exercises

Now that you have completed the Releases and Stretches, the next step is to strengthen the muscles that control the big toe.

Remember – The stronger the big toe, the more resilient it will be, the more load it can tolerate!

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a) Big Toe Lift

(Movement: Extension)

Instructions:

• Keep your foot on the floor.
• Lift up your big toe as high as you can.
• Do not move the other toes as you do this.
• Aim to feel a contraction of the muscles at the top of your big toe.
• Hold for 5 seconds.
• Repeat 20 times.
• Progression: Apply additional resistance with your finger in this end range position.

b) Big Toe Press Down

(Movement: Flexion)

Instructions:

• Place a tea towel on the floor.
• Place your foot on top of it.
• Proceed to dig and curl the tip of the big toe into the ground as to pull the towel under your foot.
• Aim to feel the contraction under the arch of the foot.
• Repeat 20 times.

c) Abduction Isometric

Instructions:

• Push your big toe out the side.
• Whilst maintaining this position, apply inward pressure with your finger.
• Press as firmly as you can tolerate.
• Hold for 20 seconds.

d) Spread/Squeeze

(Movement: Abduction/Adduction)

Instructions:

• Transition between the following positions:
• Position 1: Spread all of your toes. (without bending your toes or moving your foot)
• Position 2: Squeeze all of your toes together. (without bending your toes or moving your foot)
• Repeat 30 times.

e) Forward Lean

Instructions:

• Stand up right.
• Push your big toe into the ground.
• By moving at ankles, lean your body forwards.
• Lean as far as you can without losing balance.
• Repeat 10 times.

STEP 9: Gait Re-Training

It is essential to learn how to use your big toe properly while you are walking.

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a) Heel Raise

Instructions:

• Stand up right.
• (You can hold onto something for support if required.)
• Try tour best to keep your feet and toes pointing forwards throughout this exercise.
• Raise your heels off the ground.
• Make sure that you are applying a downward pressure into the ground with your big toe.
• Repeat 30 times.
• Progression: Perform a single leg heel raise with or without support.

b) Push Off With Trailing Leg

Instructions:

• Have your feet in a staggered position.
• (The foot at the back will be the side targeted.)
• Keep your feet and toes pointing straight throughout this exercise.
• Apply a downward pressure into the ground with your big toe.
• Raise the heel of your back leg as you shift the leading knee forwards.
• Make sure that your big toe of the back leg is extended back as far as possible.
• Repeat 20 times.

c) Walking

Instructions:

• When you are walking – be mindful of your big toe position and how you apply pressure to it as you push off the ground.
• Aim to push off underneath the big toe (as opposed to pushing off from the side).
• Progression:
  • Walk up hill
  • Walk faster
  • Jog

STEP 10: Advanced Exercises

The following exercises place even more pressure on the big toe.

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a) Lunges

Instructions:

• Perform walking lunges.
• Aim to keep your big toe of the trailing leg pointing forwards throughout the exercise.
• Repeat 10 times.

b) Mountain Climbers

Instructions:

• Assume a push up position.
• Bring your knee up to the chest.
• Alternate legs.
• Repeat 20 times on each side.

c) Hopping

Instructions:

• Start in a standing position.
• Hop on one leg.
• Repeat 20 times.

STEP 11: Side-To-Side Movements

Once your big toe is functioning better while walking, the next step is to challenge yourself with side-to-side movements.

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a) Side Toe Taps

Instructions:

• Start in a standing position.
• Reach your foot out to the side.
• Tap your big toe on the ground.
• Bring it back to the starting position.
• Repeat 20 times.
• Progression: Apply more pressure onto the big toe as you are tapping it on the ground.

b) Side Steps

Instructions:

• Take steps towards the side.
• Repeat 20 times.
• Repeat in opposite direction.
• Progression: Take larger steps to the side.

c) Side Hops

Instructions:

• Stand on one foot.
• Hop side-to-side.
• Repeat 20 times.
• Progression: Take larger hops.

STEP 12: Address foot posture

If you have big toe joint pain, you may also need to address other postural factors that might be predisposing you to this issue.

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The optimal position and movement of the big toe is lost during walking with the following postural issues:

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a) Restricted Ankle Dorsiflexion

Ankle Dorsiflexion is the movement where the ankle (Talocrural joint) is bent in a backwards direction.

An adequate amount of Ankle Dorsiflexion is required for normal walking mechanics.

If you are limited in this movement, it is common for the big toe to compensate.

My recommendation: Aim to get the tip of the big toe approximately >4 inches from the wall.

If you do not have full Ankle Dorsiflexion, look at this blog post for exercises to help improve this: Exercises for Ankle Dorsiflexion.

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b) Flat Feet

Flat Feet is a type of foot posture which involves the collapse of the inner arch of the foot.

If your foot arch collapses, the big toe is placed in a sub-optimal position to function.

How to tell if you have flat feet:

• Stand upright as you normally would.
• Observe your feet.
• There should be an obvious arch on the inside of your foot.

As a rough guideline: You should be able to fit the tips of your fingers underneath the arch of your foot.

If you have Flat Feet, check out this blog post for exercises to help improve this: Exercises for Flat Feet.

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c) High Arches

A high arch in the foot is characterized by having a more pronounced curve in the medial arch of the foot.

This tends to place the big toe joint in a hyper-extended position during walking.

How to determine if you have High Arches

• Stand up.
• Take a photo of the foot arch.
• Take note of the gap between the bottom of your foot and the ground.

Results: If there is a significant arch present, then you have High Aches in your feet.

For exercises to address this issue, check out this blog post: Exercises for High Arches.

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d) Big Toe Bunion

A big toe Bunion is a bony prominence at the base of the big toe.

This is coupled with a deviation of the big toe towards the side. (Hallux Valgus)

Since the big toe has lost the ideal alignment, this can play additional pressure onto the big toe.

For exercises to address this issue, check out this blog post: Big Toe Bunion Exercises.

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e) Duck Feet Posture

Duck Feet Posture is a postural deviation where the feet are pointing outwards.

This will point the big toe outwards as well.

How to tell if you have Duck Feet Posture

• Stand up.
• March on the spot for 5 seconds.
• Stop.
• Look down at your feet.
• Which direction are your feet pointing towards?

Results: If your feet are pointing outwards, then you have Duck Feet Posture!

For exercises to address this issue, check out this blog post: Duck Feet Posture

Other things to consider

In addition to the exercises, it is also beneficial to address the following factors as well.

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a) Wear Appropriate Shoe Wear

When wearing a shoe, make sure that there is ample room around the big toe.

(It should not be squashed!)

The 2 main shoes that tend to compress the big toe are high heels and shoes that are narrow at the front.

b) Increase Padding Under Base Of The Big Toe

If your pain is specifically located underneath the big toe, you can place gel inserts underneath the base of the big toe.

This will help provide additional cushioning and reduce the amount of pressure in the area.

c) Manage Body Weight

Any increase in body weight is likely to result in an increased amount of stress applied onto the big toe.

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Surgical Treatment

If you have persisted with the recommended exercises/stretches for at least 6 months and there has been nil improvement in your symptoms, you may need to consider surgical intervention.

(Note: Please seek medical advice regarding the following procedures to determine if they are appropriate in your situation.)

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Main surgical interventions performed on a big toe:

a) Cheilectomy: Shaving off bone spurs/protrusions in the joint.

b) Osteotomy: Cutting away of bone to re-align the big toe.

c) Inter-positional Arthroplasty: Placing a spacer between the joint.

d) Arthrodesis: Fusion of the joint.

e) Arthroplasty: Replacement of the joint.

In my opinion – Please try your best to avoid any surgery! Perform the exercises as suggested on this blog post as consistently as you can.

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Frequently Asked Questions

a) Is walking good for the big toe joint pain?

Walking is a great exercise, however, you need to make sure that you are doing it in a way that is not aggravating any pain.

For example – you might need to walk slower, use a walking aid, avoid hills, take more breaks etc.

b) Do I need to do ALL of the exercises?

In the initial stages – I strongly recommend that you perform all of the exercises.

As you become familiar with the exercises, you will start to recognize which exercises give you the most improvement.

From here, feel free to pick and choose which exercises you would like to focus on.

c) How often should I perform the exercises?

Perform the exercises 1/day.

Ideally – increase the frequency to 2/day. (If your body can comfortably tolerate it!)

d) How long will it take to fix?

Persist with the exercises for at least 3-6 months.

The recovery time frame is largely dependent on the severity of the injury, ability to avoid aggravating the big toe and the consistency of performing the exercises.

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Conclusion

If you have Big Toe joint pain, it is essential that you address this issue as soon as possible.

Although the big toe is a small part of the body, it plays a significant role in the mechanics of the lower limb.

Pain in this region can alter how you load your leg which can lead to significant compensations in the way that you walk.

The steps mentioned in this blog post offer a comprehensive strategy to help fix the pain in your big toe.

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Disclaimer: The content presented on this blog post is not medical advice and should not be treated as such. It is not intended to be used as a substitute for professional advice, diagnosis or treatment. Use of the content provided on this blog post is at your sole risk. For more information: Medical disclaimer.