Foot Pain at big toe

by Lisa
(bristol tennessee)

The base of my big toe feels like it is broke, however I have not done anything to it. This has been going on for a year now. It feels like I need to pop it, but I can't because it causes me to scream out in excruciating pain. Even under the covers it hurts like the dickens to touch it with anything. The fleshy part on top of my foot in between the big toe and the adjoining one is inflamed almost like it is fluid retention, but I know that it isn't. When I touch the side bone of my big toe it causes me to yelp with pain. I haven't dropped anything on it, I haven't stepped on it, I have never broke it, and I have never done anything to make it hurt like it does. Please help, I hobble at work becaues of it, and I have to work on concrete floors!

RESPONSE

Hi Lisa,

The thing about foot pain regardless of where it occurs on the foot, is that you do not need a history of trauma in order to develop pain. I wish I knew your age, weight, and types of shoes that you wear to work.
Even without that knowledge, the fact that you work on concrete floors lends itself to developing foot problems over time. Concrete does not absorb any shock, so all the shock created by walking ends up in your foot and leg.
Specifically to your problem, the fluid that you mention on top of the foot at the big toe joints would represent edema (swelling) probably secondary to inflammation. I doubt you have an infection as you state you have had this problem for a year now.
The most common cause of inflammation in the big toe joint would be from arthritis. If your big toe does not bend upwards easily, or if there is very little motion, then certainly arthritis would have to be ruled out. An arthritic flare up could certainly be present for a year simply because you walk on the foot regularly and because you walk on concrete floors.
You do not mention if the inside bone of the joint has a bump on it. If it is just red and painful that might indicate an inflamed bursal sac (bursitis). This is very common in a bunion deformity and again would be aggravated by the type of shoes that you wear and once again, the concrete floors would also lend a helping hand in causing pain.
Another possibility that would cause pain in the area you describe would be tendonitis of the tendon that allows you to bring your big toe upward. This condition, more so than arthritis would probably cause swelling on top of the foot.
Other conditions that need to be investigated would be the possibility of sesamoiditis and possible turftoe as well as stress fracture. All these conditions can be found on the navigation bar to the left. I believe they are lesser possibilities but again, they need to be ruled out.
You probably can see the problem here and that is there is more than one issue that may be causing your pain and obviously without the luxury of being able to examine you, I am just guessing. The fact that you are having pain for a year does tell me that this problem is not going away on its own and my best advice to you would be to see a foot specialist in your area.
The solution may be as simple as changing the types of shoes that you wear, possibly with an orthotic added to it, but only an examination by a doctor will tell you that.

Marc Mitnick DPM
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