Painful big toe

Triathlon Forum
1

I saw the stubbed toe thread but thought I’d start my own.

Last spring I developed a painful big toe. No mechanism of injury, it just started hurting. It hurts in the joint attached to the foot (sorry I’m not an anatomy person).

It doesn’t hurt when I run, but is very painful when I walk, sometimes. The day after a run is worst.

Chiro suspected arthritis - x-rays done by sports medicine doctor do not reveal this. Drawer tests do not show instability, so it’s believed that the ligaments are fine.

She told me to take Advil a whole bunch for a week and see if that helped. I did not do this because I started Lithium (I’m bipolar) and you can’t take NSAIDs on Lithium. I recently went off it (Saturday) and have started taking Advil, though I wouldn’t term it ‘a whole bunch’ (those weren’t her exact words, to be fair).

I haven’t been running much this year, for various non-physical reasons (I know, I know) but since starting back developed plantar fasciitis in my other foot (I’m managing it). If it’s relevant, the ankle in my affected toe side has had a couple of ligament tears, arthritis, and I have tedinopathy in one of the tendons on the inside of the ankle every once in awhile. I rehabbed it most recently a few years ago and was cleared to run.

2016 is going to be a year of just rebuilding my base and losing weight. I’ve plans to pace a friend at a couple of 100 milers so expect to run up to 60k with him, the first being at the end of May. So training is starting now, more or less.

I can manage the pain, but this is starting to irritate me, and I’m at a loss for what could be wrong or what to do next. A MRI seems silly for a toe. I do some toe strengthing exercises (like picking up towels), but not regularly enough.

Edit: My training program has me riding 3X/week and I see the sports doctor again on Jan. 12th.

2

Not sure what you are after with your post (didn’t even see a question in there).

You have a whole lot going on with normal X-rays, some significant history with various biomechanical injuries, and you want to get back to running up to 60K?

First thing I would suggest would be another opinion (in person that is) from a specialist and go from there based on his/her recommendations.

3

Sorry I wasn’t clear.

Question is - what could this be? If it’s not ligament or arthritis, I’m at a loss. Was wondering if anyone had experienced anything similar (though I didn’t really say that, you’re right).

As I mentioned, seeing sports doc again in January.

4

Sorry I wasn’t clear.

Question is - what could this be? If it’s not ligament or arthritis, I’m at a loss. Was wondering if anyone had experienced anything similar (though I didn’t really say that, you’re right).

As I mentioned, seeing sports doc again in January.

My suspicion is that you are not in the US? By another opinion I meant from someone else entirely, not the same person you saw.

5

I’m in Canada. I could see another doc, that hadn’t occurred to me. It’s a good idea, thanks.

6

Have you considered possibly gout? If it is gout you could treat the underlying problem of having excessive uric acid instead of just the symptom. But assuming you went through tests and got uric acid levels within normal limits i guess that would probably rule it out…

7

r/o gout as the above poster stated. No mechanism of injury and thus should be ruled out. Is it red and warm to the touch?

8

It does not take much instability to really screw up your mechanics when running. I have a bad big toe as well from a race two years ago. I now have a small spur right by the same joint and it bugs me now and then. I also have a history of fractures (4th and 5th) in the same foot. Basically, my right foot is a mess and that same ankle has way too many basketball tweaks. Really poor stability.

I will tell you I get tons of support and protection from Powerstep Pinnacle inserts. Totally love them. They are meant to help for PF and metatarsal issues. Not sure if it will help but at $30 per pair it’s an easy and cheap way to try.

9

Never even thought of gout! I’m a veggie woman in her 30s…though I do drink a lot of beer. Huh. Maybe I’ll ask to have that done. I get full blood work ups done regularly but I imagine uric acid isn’t on there.

Wow, so not on my radar. That would suck. Not that this doesn’t suck already, but it would mean less beer, and I’m into beer.

Edit: I realize this makes me sound like an alcoholic, heh. I just like trying new craft beers at our local :slight_smile: Beer is yummy!

10

Thanks! I have orthotics that I’ve started wearing again recently due to the PF. No metatarsal arch support in the bad toe foot, though there is in the PF foot. I’ll look into the inserts you mentioned too (and I spent so long weaning myself off of my orthotics).

11

No, it’s not, so perhaps not gout. That was one of the problems when the doc first looked it - does that hurt? No. Does that? No. It hurts bending my toe upwards though, if I lift it, but not if I pull it. This whole thing has me puzzled.

12

Do you dorsiflex excessively when you run? I had a short period in my running when I was starting to get plantar fasciitis in my foot. When I went to see my PT he dorsiflexed my toe and I almost went through the roof from the pain. Turns out I was overflexing my foot as I ran and was putting tendon strain on my big toe and my plantar fasciitis.

13

Did you see a podiatrist? Maybe the sports med doc missed something?

14

You can Dr. Google “Hallux limitus” which is what you are describing (most certainly not gout, pseudogout or similar). However, this is only a small piece of the puzzle. There are lots of reasons “why” that can be addressed.

This will not show on X-ray and won’t necessarily hurt unless end range dorsiflexion with weight bearing. Off weight bearing will often be normal. Again, a simple competent physical exam can ferret things out.

15

Do you dorsiflex excessively when you run? I had a short period in my running when I was starting to get plantar fasciitis in my foot. When I went to see my PT he dorsiflexed my toe and I almost went through the roof from the pain. Turns out I was overflexing my foot as I ran and was putting tendon strain on my big toe and my plantar fasciitis.

I’ve honestly no idea. I don’t think so? But I am overweight so there may be extra stress there, though this started when I was far less overweight (it’s been one of those years). My PF is in my other foot though (I dorsiflex that as a stretch).

16

A podiatrist never occurred to me. I just thing of them for orthotics. Good idea.

17

That sounds a lot like it actually, based on what I’m reading. This gives me a good starting point, thanks. And I think I’m seeing a different doc in January, though at the same clinic. Just reading up on treatments now for stuff I can do at home in the intervening time :slight_smile:

18

http://f3nation.com/wp-content/uploads/2013/08/lightenupfrancis.jpg

Just ask Sgt. Hulka.

19

Good call - saw a different doctor last night, dx early OA (despite not showing up on x-ray) and hallux rigidis. Sigh.

I’m going for physio and getting new orthotics.