Tackle Troublesome Big Toe Pain

New year equals new you! This is a very general resolution. A lot of people make them, and 2010 is unique since we’ve just begun a new decade. Resolving to change our behavior in one of the areas that will improve our health in the pursuit of increased vitality and longevity is universal. Have you ever made goals in the past to lose weight, walk more, or run a certain number of races and been hindered by a big pain in the toe?

Big toe (hallux) pain can be attributed to many things such as gout, bunions, stress fractures and ingrown toenails; however, one of the most frequent causes is a condition called hallux limitus. Essentially, it is limited range of motion of the hallux characterized by pain, stiffness, an enlarged toe joint in later stages, and occasionally swelling with heightened activity levels. It’s caused by biomechanical and structural abnormalities such as a dorsiflexed first metatarsal secondary to excessive pronation and hypermobility of the first ray or a long first metatarsal relative to the second metatarsal. Muscle imbalances including a weak peroneus longus, overpowering of the tibialis anterior, and contracture of plantar fascia and intrinsic foot muscles may also contribute to decreased hallux range of motion.

Conservative treatment ranges from casting the feet for orthotics in order to minimize some of the excess of pronation to prescribing a plate fitted for shoes that may not be rigid enough to counter the hallux hypermobility. Hallux limitus left untreated may eventually progress to hallux rigidus. Hallux rigidus is characterized by an even greater restriction of motion in the hallux and is a sign of degenerative arthritis in the big toe joint. Surgical treatment to decrease the pain is often necessary when the big toe deformity has progressed to hallux rigidus. Surgical treatment options include cleaning out the joint space, implanting a joint, and fusing the first metatarsalphalangeal joint.

Runners are generally are more susceptible to developing hallux limitus since the foot endures stronger forces when pronating during running as opposed to walking. Therefore, it’s important to see your podiatrist sooner rather than later so that conservative measures can be taken to preserve the joint. Don’t let a pain in the big toe prevent you from achieving your resolutions!