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• The most common injury of the big toe is in the joint where the big toe meets the foot. Most commonly the pain is felt deep inside the joint, but there may be some tenderness on top of the joint and toe.

• If it hurts almost entirely on top, the injury is called Hallux Limitus.

• If it hurts almost entirely on top and the joint is enlarged on top with limited ability to bend the toe upward, the injury is Hallux Rigidus.

• If the joint hurts only on the bottom, it is Sesamoiditis injury.

• If it hurts on the inner side of the joint toward the other foot and there is an enlarged joint, it is a bunion.

• If it hurts at the joint near the back of the toenail, it is an injured interphalangeal joint and not the same injury syndrome in this section.

• Toenail or end of toe soreness is covered in the nail damage section of this blog.

• The pain is usually achy and starts as a dull feeling that grows.

• yoga and walking usually causes the pain to increase during the workout as an achy feeling. In most cases, the pain decreases over several days of rest. The pain may be on the surface or on the joint, but it may also be surface pain or located near or on the bunion bump (if present).

• Pain that hurts with everyday activity and does not go away after weeks of rest from yoga/walking is more serious and should be evaluated by a doctor.

• Less common is an intense throbbing pain that is especially noticed at night and is not directly related to workout, called Gout. This is the result of a process where production of a chemical that is normally present in the body, increases significantly. The big toe joint is a common target for this substance. The body then attacks the “crystals” of this chemical as if they were irritating foreign objects. This damages the normal tissue and causes pain, redness, and swelling. Any sore big toe can hurt at night and feel stiff upon awakening, but Gout pain is intense and increases at night.

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• Sesamoiditis is noted by pain on the bottom of the foot at the base of the big toe, beneath the joint, that may feel like bruising sometimes with sharper pain qualities. Sometimes the area can swell and feel thicker. If this occurs, it is a worse injury, sometimes a fracture. See a doctor.

• Pain is caused by abnormal bending or hinging of the big toe upward where it joins the end of the first metatarsal bone. This joint is designed to allow the big toe to hinge straight up and down. Any sideways force is harmful. Some people are born with a rounder shape at the end of the metatarsal which allows the toe to move from side to side very easily. These individuals are more likely to develop a bunion as well as pain in the joint.

• Abnormal movement of the 1st metatarsal can cause toe joint pain. Doctors diagnose this problem by pushing up on the bottom of the foot beneath the base of the big toe to see if it moves upward more than usual. This “hypermobile 1st metatarsal” causes “hallux limitus” and eventually “hallux rigidus.” In many cases, the big toe is longer than the second toe, but not always. The rising of the metatarsal tightens the toe joint preventing the big toe from gliding around the hinge. This forces the top of the toe bone to collide forcefully with the top of the metatarsal bone when the big toe tries to bend upward. Over time, this stimulates the bone to thicken as extra calcium is deposited on top, sometimes forming spurs. Cartilage on the surface, that protects the ends of the bones, can wear down – a form of arthritis. In an advanced stage, hallux rigidus, the big toe loses its ability to hinge, resulting in a perfectly straight big toe.

• Pain on the bottom of the big toe joint is usually the result of an injury to two small bones called sesamoid bones that are positioned side by side, directly beneath the joint, enclosed within tendons that connect to the bottom of the big toe bone. They function as tiny kneecaps except that the force of pushing off, combined with the weight of the person directly on top, can be very stressful. They slide in grooves lined with cartilage. Impact or repetitive force can result in pain. Less common, but often overlooked is the continued and excessive pulling of the tendons that enclose them. This occurs most commonly to the sesamoid bone that is nearest the 2nd toe. The same hypermobile 1st metatarsal that causes hallux limitus causes this as well.

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