Big Toe Joint Pain

by Lisa
(Dothan, AL)

I stubbed my big toe severely and then about 3 weeks later dropped a box that weighed about 25 pounds on the same big toe. I had a steroid shot given into the big toe joint and it did nothing to help with pain. Dr also took x-ray and said that nothing was broken. She did say if I was still having problems/pain I should come back in for an MRI. I did it do that. Months later the knuckle (joint ) of my big toe still swells slightly after walking on it for long periods and it is still slightly red and still hurts especially when I try to pull the big toe in the up position. What could be wrong?

RESPONSE

Hi Lisa,

You do not mention what kind of doctor you went to. Did you see a foot specialist? I ask because if you just went to your family doctor, if they do not see a fracture, or the MRI is negative, they pretty much are lost as to what to do for you.

If you did go see a specialist, did they offer you any treatment beyond the cortisone shot?

Anyway, it is now "months" since the injury and you are still having pain. I have to ask, overall has the pain diminished from where it was lets say two months ago? In other words, do you notice it is slowly improving?

One of the problems with foot injuries is that in general they take longer to heal then similar injuries in other parts of the body. The reason is simple, you have to walk on the injured foot and every time you walk, you are essentially re-injuring the affected joint. So if you have noticed it is slowly getting better, one option is to just wait it out.

If you have reached a point where perhaps it has gotten somewhat better, but has stagnated and the pain is not improving, then you have a few options.

The fact that the toe hurts when you bend it upwards, suggests to me there may be a bone spur either on the top of the first metatarsal bone or even on the base of the toe bone. It may or may not have been present prior to the trauma, but the injury may have aggravated it. I do not know how old you are, and that would help me a little.

So, when you bend the big toe upwards, there is a jamming of the two bones and you are getting pain. This is why your foot should be treated by a foot specialist as they would recognize this.

Here is some of the things you can try, keeping in mind that I am offering this advice without ever having examined you.

1. Limit your shoe selection to low heeled, stiff soled shoes. This type of shoe lessens the strain on the big toe to have to bend upwards and thus reduces pain and allows the inflammation to subside.

2. Wear this type of shoe all the time, avoid walking around the house barefoot, as being barefoot puts the most strain on the big toe joint and aggravates the joint.

3. Try a round of anti-inflammatory medication like Advil or Motrin for at least two weeks, take the medication daily in regular doses as suggested on the package insert. This advice assumes you can tolerate that type of medication.

4. Apply moist heat like those hot/cold packs, as the heat will increase circulation to the area which promotes healing.

If the above suggestions do not work, then you should go back to your doctor assuming she is a foot specialist and inquire about the bone spur that I mentioned. You might even consider a second cortisone injection.

Lastly, you can also ask your doctor for a prescription for physical therapy which can be very beneficial in these instances.

Marc Mitnick DPM
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