hy does my big toe hurt?

Our big toe known as the “HALLUX” is crucial for balance, walking, running and jumping. It is required to go through a large range of motion as we transfer our weight forward over our foot and propel ourselves forward when walking/ running. It stabilises the foot and creates a large amount of force necessary for push off. When the big toe becomes stiff, (around the base of the big toe, as pictured below) the weight of the body has to be distributed to other areas of the body and force for push off is produced by other joints within the lower limb. As other areas begin to compensate for lack of mobility in the big toe and abnormal loading transpires through the leg complications may arise in ankle, knee hip and low back.

When the big toe becomes stiff it is called ”hallux limitus” this may progress to a point where there is no available movement in the joint; “hallux rigidus.”

Hallux limitus may be functionally related, meaning stiffness and pain are only evident during weight bearing as the bones of the big toe jam against each other. This jarring overtime may lead to additional bone growth and cause further limitation. Causes of functional hallux limitus include: length of bones within foot and toe, running on toes, wearing high heels and trauma.

Hallux limitus may also be structurally derived. The difference is restricted range of motion is noted in both weight bearing and non-weight bearing. It is usually due to a progression of injury to big toe and structural changes will be evident on x-ray. Structural hallux limitus may eventuate into hallux rigidus.

The following complications may arise as a result of reduced mobility of the big toe

  1. Lower leg pain – reduced ankle range of motion leading to increased calf tightness and achilles strain
  2. Knee pain – compensating for reduced ankle range the knee spends more time in flexion and bends early during gait causing abnormal loading through joint surfaces
  3. Hip/ low back – decreased hip extension due to lack of ankle mobility causing hip flexors to become tight and overworked

Some quick at home tests you can do include:

  • Observe the knuckle of the big toe when walking – does in bend easily, can you push through the first toe with minimal effort?
  • Is there pain when pulling toe backwards or only when weight bearing?
  • Available range of motion – big toe can normally be flexed back about 45-60*
  • You may experience more pain with walking the running. This is because the big toe is actually required to go through a larger range of movement when walking compared to running

Treatment options include

  • Change in footwear
  • Softer running/walking surface
  • Ice, compression, strapping
  • Physiotherapy – joint mobilisation, foot strengthening

In summary, it is important to consider the big toes and foot loading mechanics in all lower limb injuries.

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