Big Toe Pain?? What is causing? Help!

[TaperPin]

Having been married to a gal working in a podiatrists office, I’d bet lunch at the Outback (love that roast beef sandwich!), the podiatrist will have a preference for hard or not so hard custom orthotics, in addition to as many office treatments as your insurance will fund. Those hard orthotics are amazing and not only do they change how weight is distributed, but how you walk and you’ll wish you had them sooner. There may be something else going on in there, but with proper arch support the toes are just along for the ride.

 

[gostovp]

Having been married to a gal working in a podiatrists office, I’d bet lunch at the Outback (love that roast beef sandwich!), the podiatrist will have a preference for hard or not so hard custom orthotics, in addition to as many office treatments as your insurance will fund. Those hard orthotics are amazing and not only do they change how weight is distributed, but how you walk and you’ll wish you had them sooner. There may be something else going on in there, but with proper arch support the toes are just along for the ride.

Yeah I’ve heard this… that they will push visits and custom orthotics hard…

 

[ChrisAU]

They are too big for you I bet.

I just went through this with Crispi Lapponia 11.5's. I normally wear an 11 wide, those were out of stock this summer so I sought out a good deal on 11.5's. Felt like they fit great, BUT I felt some pressure on the top of my toes that quickly went away every time I wore them.

Fast forward to the top of a mountain in CO a couple weeks ago, boots felt great. But at different specific times I felt like my big toes were breaking, lasted about 2-3 minutes while standing still. Always kept full movement, boots still felt very comfortable, I wasn't feeling any pressure at all from the boots ever.

Then we get home and I wean myself off my steady diet of ibuprofen that I always get on when I'm in the mountains. Within two days both big toes go completely numb (Friday morning after getting home Wednesday). I go to doc on Monday, both are still numb but the right one is having random pains. Circulation/color is good. Doc tells me I probably compressed some nerves and gives me a steroid. That was last Monday, today, week and half later, they are almost 95% back to normal I'd say.

All my research on it leads me to believe that the initial pressure I felt from the crease over my big toes when I would step didn't actually go away - it just numbed my toes and beat the crap out of them. Never bruised, but just repeated pressure damaged nerves. That crease in the boot wouldn't put pressure on my toes if it were further back and lined up with the bending of my toes/foot.

I have 11 wides and 10.5 wides coming today from Crispi to try out.

 

[sbaker0029]

Just curious if you have ever experienced gout. For a lot of people it starts with joint pain in the big toe or toes.
Give it a quick Google and see if any other symptoms line up for you. If not definitely get into an orthopedic doctor.
Good luck!

 

[gostovp]

Not sure if an 11 would work, as in most 11’s unless they run big, my toes will just slightly contact the front of boot on downhills, especially with a weighted pack on.

 

[gostovp]

Just curious if you have ever experienced gout. For a lot of people it starts with joint pain in the big toe or toes.
Give it a quick Google and see if any other symptoms line up for you. If not definitely get into an orthopedic doctor.
Good luck!

Yes I’ve had gout, and this seems different.

 

[gostovp]

They are too big for you I bet.

I just went through this with Crispi Lapponia 11.5's. I normally wear an 11 wide, those were out of stock this summer so I sought out a good deal on 11.5's. Felt like they fit great, BUT I felt some pressure on the top of my toes that quickly went away every time I wore them.

Fast forward to the top of a mountain in CO a couple weeks ago, boots felt great. But at different specific times I felt like my big toes were breaking, lasted about 2-3 minutes while standing still. Always kept full movement, boots still felt very comfortable, I wasn't feeling any pressure at all from the boots ever.

Then we get home and I wean myself off my steady diet of ibuprofen that I always get on when I'm in the mountains. Within two days both big toes go completely numb (Friday morning after getting home Wednesday). I go to doc on Monday, both are still numb but the right one is having random pains. Circulation/color is good. Doc tells me I probably compressed some nerves and gives me a steroid. That was last Monday, today, week and half later, they are almost 95% back to normal I'd say.

All my research on it leads me to believe that the initial pressure I felt from the crease over my big toes when I would step didn't actually go away - it just numbed my toes and beat the crap out of them. Never bruised, but just repeated pressure damaged nerves. That crease in the boot wouldn't put pressure on my toes if it were further back and lined up with the bending of my toes/foot.

I have 11 wides and 10.5 wides coming today from Crispi to try out.

yeah I definitely can see your case as a fitment issue with the boot. No pressure on my toes on the top, feels like pressure/ pain on the sides/bottom

 

[sbaker0029]

Yes I’ve had gout, and this seems different.

Gotcha.
Sorry reading back over your post I see that mentioned towards the end of the last page.

Hope you can get into to that ortho fairly quick and get things figured out. Foot problems are never good.

 

[Maki35]

I think it's a fitment issue. Some (brands) boots will fit one person but not another.

Have you tried putting the same milage on a different brand of boots to see if the pain re-occurs?

I brought a pair of duck boots for bird hunting. They were comfortable and fit fine. But after 6hrs of walking in them, I felt pain on the top of my foot (bone). After the hunt, there was pain & numbness to the top of my foot. I've never experienced this with any of my other hunting boots.
I exam the boots. I think the seam was pinching down on my foot when I walked.
I switched to a pair rubber boots. No pain, no issues.
(I have a pair Sorel's to remove snow around the house. never had any issues or pain.) I think it was just those boots didn't fit me.

 

[TaperPin]

Yeah I’ve heard this… that they will push visits and custom orthotics hard…

If you go with orthotics just be prepared for some breakin time - not for the orthotic, but for your feet. Living a lifetime with normal shoe/boot support doesn’t automatically prepare your arches for taking more of the load. Wear them a little bit each day and increase over time.

Personally, my feet hurt in many different ways without a stiff arch that provides significant height, and I don’t have high arches. Hiking or work boots have to be stiff enough the arch doesn’t give much and transfer more of the load to the heel and balls. If I can flex a boot‘s arch with hand pressure I don’t even try them on. Asolo makes stiff arches in most of their better nylon boots, and normally runs on the narrow side, but they offer different widths that are often on sale. I’m not suggesting these are what you need, but it’s an example of what a long search has turned up for me. Different boots, different widths, different insoles are all worth trying if the podiatrist doesn’t fix it.

I do use the $90 green arch supports sold at REI and many boot stores for extra arch height and that has been enough for 3 decades, but if not I’ll have a set of hard insoles made.

 

[mthomasondpt]

Yeah I’m wondering if it’s some arthritis.
I’ve had gout flare ups in the past but as long as I stay away from bananas and too much alcohol I usually have no issues with that. My paternal grandmother had bunions something bad that eventually got surgically repaired.

Hey man, just came across this thread today. I'm a physical therapist and help with stuff like this all the time. Gout is certainly a possibility as a culprit, especially since your pain is on both sides simultaneously. However, you could have stiff big toes. Whether that is from arthritis or just plain stiff doesn't really matter because either way you still need to improve their mobility to help you out. If you are flat-footed, you likely haven't used their full range of motion (ROM) because your foot is compensating for that ROM elsewhere throughout your foot because it is so flexible. So, when you lock all that into a boot that is relatively stiff, you can't compensate as much anymore. It may not be severe, but add in miles throughout a hunt and the stress on your big toes just builds up over time. The joint at the base of your big toe should have at least 70 degrees in it to bend upward (extension). Since you wouldn't have a tool to measure that, can you eyeball it and see how much motion you have there? I can give you lots of options for stretching and mobilizing depending on what and where is most tight.

 

[gostovp]

Hey man, just came across this thread today. I'm a physical therapist and help with stuff like this all the time. Gout is certainly a possibility as a culprit, especially since your pain is on both sides simultaneously. However, you could have stiff big toes. Whether that is from arthritis or just plain stiff doesn't really matter because either way you still need to improve their mobility to help you out. If you are flat-footed, you likely haven't used their full range of motion (ROM) because your foot is compensating for that ROM elsewhere throughout your foot because it is so flexible. So, when you lock all that into a boot that is relatively stiff, you can't compensate as much anymore. It may not be severe, but add in miles throughout a hunt and the stress on your big toes just builds up over time. The joint at the base of your big toe should have at least 70 degrees in it to bend upward (extension). Since you wouldn't have a tool to measure that, can you eyeball it and see how much motion you have there? I can give you lots of options for stretching and mobilizing depending on what and where is most tight.

Hey this is great! I will take some pics an post the ROM of my big toe

 

[Mule3006Elk]

All good advise.
Agree with PT. He is referring to Hallux Limitus as previously mentioned.

FWIW: I changed boots, x 4, dropped $1800 on boots, all boots had the same issue. 3 different brands, sizing, etc. As some point it will be obvious if it's not a boot issue. LOL. I should have realized something changed instead of assuming it was a boot issue. Meaning, boots never bothered me before.

I tried carbon fiber insoles. I think they worked but it made the toe box too tight IME.

I think the problem with hallux limitus and a lot of mountain boots is the toe rocker. A generous toe rocker and this condition don't go hand-n-hand. Toe extension (toe rocker), causes the proximal phalynx and the metatarsal to contact/irritate on the ventral bone regions.

Flat, stiff soles or insert, wide toe box.

In addition to PT comments, if this is in early stages, working on ROM can be helpful. Either way if it's arthritic or loss of ROM: flat shoes, no or minimal toe rocker, stiff soles, wide toe box, ROM exercises.

If it's more advanced probably won't help a ton.

Good example if I wear flat shoes, walk barefoot, all is well. If I wear cowboy boots which force the 1st MTP into extension I will get irritation. Status post surgery, for me it's about knowing/understanding the exacerbating factors. It will never be what it was but doing the above the condition is grossly stable and nonprogressive. Also, hunting boot, I wear Kenetrek (stiff sole), green inserts from REI, apply 1-2 mm of tape on underside of orthotic of the 1st MTP joint, to counter toe extension, and I don't lace the toe area of the boot tight. Loose in fact.

Regards

 

[gostovp]

Here are some pics of the ROM on each of my big toes

 

[mthomasondpt]

Here are some pics of the ROM on each of my big toes

Wow, your ROM doesn't look nearly as bad as I thought it would. One quick thought, can you achieve that same amount of range if your ankle is in full dorsiflexion (bring the top of your foot as far up toward your knee as you can, make sure it stays there, and then re-check your toe ROM). @Mule3006Elk had great suggestions above. I'll add in some of the stretches and things I was mentioning before, but give me a day or two since it will be a longer post.

 

[mthomasondpt]

Wow, your ROM doesn't look nearly as bad as I thought it would. One quick thought, can you achieve that same amount of range if your ankle is in full dorsiflexion (bring the top of your foot as far up toward your knee as you can, make sure it stays there, and then re-check your toe ROM). @Mule3006Elk had great suggestions above. I'll add in some of the stretches and things I was mentioning before, but give me a day or two since it will be a longer post.

Here are some pics of the ROM on each of my big toes

Okay @gostovp , here are a few quick thoughts. For reference, FHL = flexor hallucis longus... one of the muscles that pulls your big toe downward.

To stretch your calf, roll up a bath towel and put it on the ground. Set your forefoot on the towel and keep your heel down on the floor. Keeping your knee straight, lean forward until you feel a stretch in your calf.

To stretch your ankle, use the same set up as above. This time, instead of keeping your knee straight, bend your knee and drive it forward over your toes. You MUST keep your heel down. You should feel the stretch lower down toward your ankle. An important point is to make sure your knee cap is pointing out in the direction of your middle toe (i.e. NOT toward your big toe or more medial than that).

To stretch your FHL, do the exact same thing as the calf stretch above, but grab a strap or rope and put it around your big toe (dog leash works great). Lean forward until you start to feel a slight stretch in your calf, then pull up on your big toe however far you can. If you can’t pull it back as far as you did in your picture, you have a tight FHL. You could do this also when sitting by grabbing your foot, pulling it back as far as you can, then using your other hand to stretch your big toe back.

To strengthen the muscles that control this motion of your big toe, work on flexing it (bending it down) as far as you can. You’ll need something to resist this to really strengthen the muscles though. You could apply resistance with the strap/rope/leash you used to stretch before. You could also use an elastic band if you have any, or grab one from Amazon or something. There are more complex exercises for strengthening this that would be good, but this is a decent start.

 

[gostovp]

Wow, your ROM doesn't look nearly as bad as I thought it would. One quick thought, can you achieve that same amount of range if your ankle is in full dorsiflexion (bring the top of your foot as far up toward your knee as you can, make sure it stays there, and then re-check your toe ROM). @Mule3006Elk had great suggestions above. I'll add in some of the stretches and things I was mentioning before, but give me a day or two since it will be a longer post.

Here’s pics the best I could do while in dorsiflexion.

 

[Mule3006Elk]

How much passive dorsiflexion do you have?

Meaning don't use your fingers to assist.

 

[gostovp]

Here is passive dorsiflexion

 

[Mule3006Elk]

Assuming that is full effort you have restricted ROM.