Mr James Stanley is a Consultant Foot and Ankle Specialist at Clifton Park Hospital who has been treating all types of foot and ankle conditions for many years, and has a wealth of experience in diagnosing and treating pain in the big toe including keyhole surgery.
Is your big toe causing pain and disability? Are you having to avoid shoes you want to wear or can’t exercise because your foot hurts too much? Do you not like how your foot looks and want to discuss surgical options? If the answer to these questions is YES then you may wish to seek advice. Being ‘fed up’ with your foot problems and struggling to get effective treatment can be an issue for some people, however there are a number of surgical and non-surgical treatments available.
The foot is extremely complicated with 26 bones and 100 muscles, and seeking specialist advice may be the best way for you to get an explanation for your pain and get a comprehensive discussion about your treatment options.
Why does my big toe hurt?
The big or great toe (known medically as the hallux) can be a significant source of pain and disability. The pain can be a frustration with shoe choices, interfere with exercise and fitness or even simple day to day activities. Thankfully a specialist should be able to help identify the cause and offer a treatment for the majority of painful big toe issues. Having a functioning and pain free big toe is very important in walking properly, wearing shoes comfortably and being efficient when running and exercising. There are a multitude of reasons why the great toe might hurt but there are some common reasons such as bunions, arthritis and gout. Lumps and bumps around the big toe can also cause anxiety due to how they look or cause problems with the other toes such as clawing and pain of the lesser toes, and in the ball of the foot.
Why does my bunion hurt?
A bunion or bump is most often associated with the big toe moving towards the other toes, known medically as a hallux valgus. It is caused by one of the main bones of the foot (a metatarsal) moving out of position. The metatarsal is normally nice and straight. When a bunion forms the metatarsal slowly twists outwards and the big toe slowly moves inwards towards the other toes. The classical bunion bump then forms on the inside of the foot. The reason why a bunion forms is thought to be partly genetic and partly due to shoe wear, but often we never know for certain.
The reason bunions hurt is because the bump presses on the inside of shoes, becoming increasingly sore depending of the activity level, the tightness of the shoe and the length of time spent in shoes. Bunions are typically less painful when there is less pressure on such as when wearing soft wide fitting shoes or sandals. The pain is exacerbated by tight or pointy shoes particularly when with a high heel.
What can I do to help my bunion pain?
As mentioned changing shoes can help and discussion with a podiatrist can also be valuable. The podiatrist will be able to look at some of the other issues which can accompany a bunion such as flat feet or pressure problems with the other toes which when treated can help the bunion. It’s also quite common for people to develop clawing of the second toe with a bunion which can also be sore. A podiatrist can also advise on use of insoles and types of shoe, help with hard skin build up amongst other foot care issues.
When should I speak to a consultant?
If your bunion is sore and increasingly disabling despite your best efforts then surgery may be in your interest. Your podiatrist or therapist might also recommend you seek an appointment with a consultant specialist. An x-ray is often required to look at the degree the metatarsal has twisted and to look for any associated issues.
Another reason to see a consultant is when the bunion is associated with painful clawing or hammering of the other toes. Surgical correction of the big toe can help enormously when combined with lesser toe surgery, especially if there is pain under the ball of the second or third toe. Rarely sores can develop between the toes because of rubbing of the big toe on the one next to it, or the big toe begins to cross over the other toes which can cause problems with shoes and may again benefit form surgery. Surgery can be helpful for some patients and may be the best way to help with the problem. The surgery involves correcting the position of the bones of the foot so they align straighter again to get rid of the bunion as well as straightening the big toe. It is usually performed as a day case and patients are usually mobile immediately afterwards, albeit slightly slower and encouraged to recuperate. Other foot issues such as the clawing of toes may be addressed during the same procedure.
Why is my big toe stiff and sore?
Stiffness of the big toe is known medically as hallux rigidus or hallux limitus. The most common cause is arthritis and the most common cause of big toe arthritis is probably an innocuous injury many years before. As the big toe becomes arthritic it often develops an extra lip of bone or bump on the top of the main joint. The bump blocks toe movement and causes the stiffness. It can also rub in shoes a bit like a bunion. Pain is often described as a dull or deep pain with sharp pains particularly from the top of the joint, but it can be a mixture of pains all over the joint. Either way increasing activity can exacerbate the pain as does certain types of foot wear including poorly supportive shoes and high heels.
What can I do about my stiff and painful big toe?
The pain can be reduced by having stiffer shoes which stop the toe moving. Less flexible trainers, walking shoes/boots and hard soled sandals can all help. A podiatrist can also make insoles for your shoes which help. Like many arthritic conditions painkillers and steroid injections can keep the pain at bay and may be offered by your GP or podiatrist.
When should I speak to a consultant?
Surgery is a good choice for patients who are still struggling and want a more permanent solution. The surgery ranges from a simple clean out of the joint through to fusion of the joint and joint replacements. The decision as to which is best for you would be based on your
x-rays and a long discussion with your consultant. Each procedure has its advantages with the decision also reflecting your lifestyle choices such as exercise demands and choice of shoes including high heels.
What is gout?
Gout is an arthritic condition caused by small crystals of uric acid forming in the joint. The gout crystals are due to your body breaking down a chemical in food known as a purine. In some people the breakdown of purines leads to a higher level of uric acid and the crystals form.
Gout is surprisingly common and can affect any joint in the body but most commonly affects the big toe. It can less commonly also cause lumps under the skin known as tophi. The symptom most patients experience is a hot, swollen, red joint which is very painful. The pain can come on quickly but usually subsides over time, known as flares and remission. Unfortunately without treatment this can be a recurring problem but may be months or years between flare ups.
What do I do if I think I have gout?
Thankfully gout can be treated by your GP in most cases. A simple blood test or sample of joint fluid from an acute flare up can help with the diagnosis. Once diagnosed your GP will be able to provide medication to treat flares and also prevent them from happening in the future. A diet lower in purines is also helpful. A search online will be very informative as red meats, and alcohol can cause problems as can healthier foods such as some fish, tomatoes and asparagus.
When should I speak to a consultant?
Thankfully the majority of patients with gout never need to see a surgeon. There are rare circumstances in which your GP should be able to advise you to seek an appointment in such cases.
What we sometimes forget to tell you:
There are small bones under the big toe joint called sesamoids. These are like little knee caps and can be a source of pain under the big toe.
Pain in the ball of the foot, or toe clawing can be due to the big toe not working properly.
Stress fractures (march or policemen’s fracture) in the foot can also be due to the big toe not functioning properly.
Many big toe problems can be effectively treated by a podiatrist and changes to the type of shoe worn.
Patients can walk straight away after the majority of big toe surgery but the foot is often sore and swollen which should settle over a few months.
The scars are pink for a few months after surgery but become pale over time, often becoming difficult to see.
Most patients are surprised at how little the pain is after surgery, with simple pain killers all that is needed for a few days or weeks afterwards.
Bunions can recur over the years although it’s not very common to need more surgery as for most even when they come back they don’t hurt enough.
A small proportion of patients can have complications which may require further treatment.
After right foot surgery most patients are advised to not drive for 6 weeks. After left foot surgery some patients can drive an automatic car earlier.
Tel. 01904 211663