Big Toe Joint Pain

Hi, I have been getting intermittent pain on the top of my big toe joint on my left foot for almost a year. It gets worse after a long hike or playing soccer for a short time. At first, I thought it was due to my calves being very tight, but after stretching them out every day for a few weeks using a calf stretcher, although the pain occurs less frequently, it’s still there. I have also stretched out all my other leg muscles which were also tight (I do an office job, sitting down for a lot of the day, creating tight/short muscles), but the pain still persists. Recently it got quite bad after playing soccer and was accompanied by shin splints down the outside of my left leg. I thought it might be due to tight shins, as I hadn’t been stretching these. This is when I realized I could bring the pain on every time without fail by doing a Standing Anterior Tibialis Shin Stretch. As soon as I do this stretch, the pain on the top of the big toe occurs. Interestingly, if I apply pressure on the top of my big toe when not in this stretch, I can’t bring the pain on. I’m therefore wondering if it is indeed due to tight shins. But as doing the stretch causes the pain, I’m unsure if it’s helpful to do it. Any help on this matter would be much appreciated. Thanks for taking the time to read this.

I have to express first that without taking a detailed look at you, it is hard to sift through all of the potential variables and contributors to your symptoms. Any advice I give you is limited by this fact. There is no substitute for having a skilled physiotherapist look at you. It is possible your big toe pain is referred down from your anterior tibialis muscle, or even a nerve (like your deep peroneal nerve). I suspect it is more likely that it is the MTP joint (or the knuckle joint) of your toe. The stretch you’re describing puts a lot of pressure on that joint, perhaps a lot more than when you manually push on it.

If it is the 1st MTP joint, it would often be a big thickened around the joint line (a bit swollen and perhaps the bones being a bit more prominent), a bit tender around the joint line, and perhaps bent in towards your 2nd toe. If you have none of these things, it doesn’t rule out a MTP problem, but it may indicate something else happening.

A problem like gout can’t be ruled out either, although the flare ups are often more related to eating and drinking habits.

You are on the right track to work on the mobility of your ankle and leg. There may be a few more factors involved, like the strength and control of the muscles that operate around your foot- especially your ‘intrinsic’ muscles of your foot and the muscles that twist your foot in and out. Physiotherapy prevailing wisdom has moved on a little from looking at foot posture (as in flat foot vs. high arch) as the key to foot problems. Many people with high and low arches have no problems. With all that, if you have a high arch, it may make it more likely for your mid-foot to be stiff, for your big toe to have mobility forced upon it, and for you to get tight down the outside of your lower leg. You can’t change your posture, but the right combination of working on your whole leg strength and control, using strategies like appropriate rest, footwear, strapping or taping of your foot, or orthotics to even the load through your foot could give you some relief. Very often, you compensate due to the pain and that asymmetry with your movement can perpetuate the problem.

I would suggest you seek a physiotherapist out to work out what you need. There is a good chance you can get this settled down and return to normal activity.