The smallest bones, joints and muscles in our body are in our toes. When we jump up and side to side, they provide stability and shock absorption when we land, and they stabilize the space between the bones.
Toe pain can be caused by the type of footwear worn, the amount of time one spends on their feet, the type of floor or surface one works on, one’s age, and one’s underlying medical conditions.
Footwear that is too short in length can cause toe pain. They can either hit the end of the shoe, or they will curl under (grab) to avoid your toes hitting the end of the shoe. This causes the smaller joints in the toes to pull up, leading to skin irritation on the top of the toes. The second toe is most commonly affected. As a result of this, the bottom bones of our feet can feel like we are standing on rocks or hard peas.
This can be felt under all the toes from one to five, or toes two to four. This is referred to as metatarsalgia.
If footwear is too narrow and tight, this can also cause pain. If you feel pressure against the edge of the big toe and your baby toe, this means your footwear is too tight. When you see redness in the bare skin at these areas, it can lead to pain and possibly bunions (big toe) or bunionettes (baby toe) in the future. The big toe can also become angled inwards towards the second toe. It has the potential to underlap or overlap the second toe. Pain may result because of the extra space it takes up in footwear especially if it comes to a point at the end.
The thickness of the soles of footwear also plays a part. If it is thin and or pliable it needs to be thicker to better support the bottom and sides of your feet. An example of this would be a hiking boot. When the middle layer (midsole) between the fabric of the shoe and the outsole is thicker, this may help alleviate the onset of most toe related pain.
When an indescribable pain is felt between the toes (3rd and 4th most commonly), this can be a nerve pain called neuralgia or Morton’s Neuroma. This can be caused by footwear that is too tight and in combination with a raised back heel. The greater the heel height, the more pressure is felt at the ball of the foot. When the foot is squeezed from the sides, this can cause the nerve(s) between the toes to become inflamed. This can develop into a neuroma. Continuous wear of a high heeled shoe or similar can be a significant source of pain. Footwear that is relatively the same height at the heel as under the ball of the foot is recommended.
Surfaces we stand and move on can also be a factor. Tile flooring is comparable to concrete. Both are harder surfaces than paved asphalt we drive on. To help reduce toe associated foot pain, structurally sound lace up footwear is recommended for maximum comfort.
As we age, the arch at the ball and bottom of our foot (metatarsal arch) begins to collapse. The arch may also collapse earlier in life from rapid weight gain (such as pregnancy), activity level and the muscle not getting used frequently. As this arch collapses over time, we may feel metatarsalgia symptoms. This pain could be felt all day or later in the day. The pain felt all day is associated with the bone ends of the toes and the capsule underneath being impacted. It is most common for the base of the 2nd toe to be affected and become inflamed. Pain felt later in the day is tendon related. This is typically due to blood flow restriction. The pain subsides with sitting and non-weight bearing rest.
Osteoarthritis pain affects the ends of the bones and can feel like an ache. The pain or discomfort can be more general in area. Rheumatoid Arthritis pain in the toes is different. Toes can become more inflamed and swollen like in size. The pain can subside with heat or ice treatments.
If you have toe pain, talk to your Canadian Certified Pedorthist. They would assess your foot pain and present you with treatment options based on your areas of complaint. This could include a custom foot orthotic along with footwear recommendations to get you back to your healthy normal. You can find a Pedorthist at https://www.pedorthic.ca/.
Written by Richard May, C. Ped (C)