Pain Under The Toes? Read All About It!

I was asked the other day about a pain directly under the big or “great” toe joint.

This is a common complaint among runners and athletes. This area of the foot is the point of propulsion when walking and running. It acts as the last point of lift off before the foot leaves the ground. Here are common problems that can be found at the ball of the foot below the first toe joint.

Hammertoes: This is one of the most common complaints among our patients. There are three main types of hammertoes but for this blog it is important to know that a hammertoe is any abnormal flexing at the joints of the big toe or other toes. This can be caused by tight tendons, joint capsule or abnormal bone structure. This causes the metatarsal bone (long bones of the foot) to be prominent and absorb too much shock. This leads to pain under the big toe joint with calluses at the other joints of the big toe. This can generally be treated with wider or deeper shoes to accommodate the deformity. If painful enough and if not able to treat conservatively, surgery is often indicated. This is a minor outpatient surgery that usually has good results.

Bunions: Pain on the inner part of the big toe joint accompanied by a large boney prominence is considered a bunion. This generally does not display on the underside of the big toe joint.

Sesamoid fractures: Below the big toe joint are two small round bones called sesamoids. These are common in many joints around the body. With too much pressure on the big toe joint, these small bones can fracture. This pain is generally limited to directly under the first joint at the ball of the foot. Rapid dramatic inflammation with significant pain is common complaints. This can be painful enough to prevent walking at all.

Sesamoiditis: When repetitive pressure occurs to these two bones in the absence of a fracture it causes an acute inflammatory activity that is known as sesamoiditis. This is the general inflammation to the sesamoids and the ligaments surrounding them. This can be a more diffuse pain to the general area.

Capsulitis: Inflammation to the capsule around the great toe joint is capsulitis. Repetitive trauma or excess motion across the joint can cause the tendons, ligaments and capsular tissues to get inflamed. Wearing non-supportive shoes like minimalists, flip-flops or thin flats allow the big toe to bend more than it should. If not prevented it can cause pain and swelling with motion. This is relieved with rest, ice, anti-inflammatories and shoe gear changes.

Turf toe: This is a common injury in sports on artificial surfaces like turf. Turf toe is actually an injury similar to capsulitis when the big toe joint is bent back far enough that it tears the joint capsule and the ligaments between the sesamoids. This is a common football and soccer injury when an athlete tries to pivot and the toe bends back too far. Often a “popping” sensation is felt and pain and swelling starts quickly. This is an acute event, meaning that most people know exactly when it happens. It isn’t something that slowly comes on and gets worse. If the symptoms are slow it is more likely to be capsulitis or sesamoiditis. Shoe gear changes like a stiff plank across the joint can help reduce pain by limiting motion at the joint. If the tear is bad enough surgery may be indicated to repair the joint and ligaments.

The big or “great” toe can cause big problems. In most cases, the right changes to foot wear can help prevent injury or reduce pain. So much is asked of this first little piggy isn’t it only fair that it deserves more attention than the other 4?

To learn more about pain under toes or anywhere to the foot and ankle please contact: Dr. Jeff Bowman of Houston Foot Specialists at 713-467-8886 or online

2013 Jeff Bowman., All Rights Reserved

Category: Foot Problems

Tags: Bunions, Capsulitis, foot pain, Foot Problems, Hammertoes, Sesamoid Fractures, Sesamoiditis, Toe Pain, Toe Problems, Turf Toe