The Doctor Is In

Q: A couple of nights a week, I get sharp pains in my big toe. With no injury to blame, what could be causing it?

Ouch! Most of the time, we don’t think much about our big toe. It’s usually just hiding out under our socks and shoes or displayed to the world while at the beach or the nail salon.

But, that all changes when you develop a severe pain in your big toe. It can be so disabling that it might make it hard to walk or even sleep through the night.

Every time you take a step, this tiny joint has to bear about 50 percent of your body weight. So, let’s look at the common reasons why this little piggy may drive you crazy.

One common condition causing big toe pain is a bunion. Bunions, also known as hallux valgus deformities, are caused by a mal-positioned big toe joint, which then leads to a widened forefoot and a red, irritated and sometimes swollen bump on the side of the big toe. The big toe may move toward or under your second toe, as the joint gets further out of alignment.

Wearing tight-fitting shoes can cause and make these bunions worse. If you ditch the high heels and wear flat shoes with extra space around the big toe, this will help. Also, placing a pad over the bunion will help prevent irritation.

Arthritis is another very common reason for your big toe pain. The big toe joint is a common site for “wear and tear” osteoarthritis where the cartilage between bones degenerates as we age. Most common symptoms include pain, swelling and stiffness, which may be worse first thing in the morning.

If the arthritis progresses, some people develop a condition where the big toe joint stops being able to bend at all, called hallux rigidis. Some also develop bony spurs, which form on the top of the big toe joint.

Depending on the severity, anti-inflammatory medications and other prescriptions may be necessary, although ice, physical therapy or over-the-counter Tylenol may just do the trick.

There are other forms of arthritis that can also cause debilitating pain in the big toe, including rheumatoid arthritis and psoriatic arthritis.

More common, however, is a metabolic condition called gout. This happens when uric acid builds up in a person’s blood and can form needle-shaped crystals that get deposited in the big toe joint, causing exquisite pain, redness and swelling.

Gout is often associated with some famous people in history, including Henry VIII and Charlemagne, but is still a common affliction nowadays in the U.S. Certain foods can be linked to causing gout attacks, including beer, organ meats and shellfish, although sometimes this is an inherited condition.

Treatments include medicine to treat the inflammation of the toe, but if this is a recurring problem, there are also medicines to bring down the uric acid levels in the blood.

Finally, under the category of “who knew,” we all have sesamoid bones of the foot, which are two tiny bones found near the big toe joint. They sit within a tendon that flexes the big toe downward.

These bones can get inflamed or even fractured from activities that involve balancing on toes or jumping such as ballet dancing or basketball. Rest and shoe inserts may be helpful for this condition, but crutches or a cast may be necessary to treat severe cases of sesamoiditis.

Albert Einstein once said, “When I was young, I found out that the big toe always ends up making a hole in a sock. So I stopped wearing socks.” Just like Einstein, you too should pay attention to that big toe.