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The response to the question below was authored by Marc Mitnick DPM

Nerve pain in big toe??

by Lou
(Bend, OR)

Whenever I put any downward pressure on my big left toe (walking, running, etc.) I have a painful sensation. It feels as if I have a blister on the bottom of that toe and when pressure is applied, there is a "give" sensation like I am missing some skin or fatty tissue in that area. Sometimes there is a burning sensation, other times just the "give" sensation. If I tape my big toe with athletic tape prior to a run, I only feel the "give" pain every 3 or 4 foot strikes instead of every foot strike without tape. I do have metatarsalgia on my left foot with a slightly curved 2nd toe (toe next to affected big toe) which tends to rub against the big toe. Could this rubbing of these toes over a 7 or 8 year period cause some kind of nerve damage in my big toe?



Anyone else ever experience this type of toe pain?

Thanks!

RESPONSE

Hi Lou,

A few potential problems come to mind regarding the pain on the bottom of your great toe.
The first would be an accessory bone which is found in some people. This bone, although it is actually cartilage rather than true bone, lies directly under the great toe, at the level of the joint.
If you press on the bottom of the toe, many times you can actually feel the bone and move it back and forth slightly.
Because of its location, it is subject to constant pressure in walking and particularly running, so that it can begin to hurt. It could give you that
sensation of having a blister, even though you do not.
Sometimes, there will be a slight callus on the skin, associated with this accessory (extra) bone.
The next thing that comes to mind is an irritation of what is known as the flexor tendon. This tendon brings the big toe downward.
Certainly an activity like running could aggravate the tendon and I have seen it many times. The problem here, like many foot problems is that because you are constantly walking (and running) on the injured area, the painful area can take forever to heal.
Another thing that comes to mind is a possible nerve entrapment of one of the nerves that gives you sensation into the toes. There are four proper digital nerves that run into the big toe with two of them being on the bottom of the toe. One of these may have become inflamed.
The last thing that comes to mind in common causes of pain on bottom of toe would be an inflamed bursal sac, other wise known as a bursitis. The constant "banging" of the toe could cause the body to produce a bursal sac on the bottom of the toe which then becomes inflamed and will cause pain.
You now have to decide how much this problem bothers you. If it has been going on for a few weeks and shows no signs of subsiding or if it is very painful then the smart move would be to see a foot specialist who should be able to identify the source of your pain and institute appropriate treatment.

Marc Mitnick DPM
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Feb 13, 2012
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by: Lou

Thank you very much for your response! I actually have been having this toe issue for a few years and have just lived with the discomfort. I play tennis, run and/or cycle at least 5 days a week. The taping I described helps a little. I actually saw a foot doctor about 6 months ago, and unfortunately, I had a blister on the affected toe at the time that had nothing to do with my problem and he thought I may have had a plantar wart. When I explained my symptoms, he did not seem to listen and continued to think it might be a plantar wart. Well, the blister went away and there are no markings of my toe that in any way resembles a plantar wart.

Armed with the info you sent me, I think I'll find a new foot doctor and this time I'll be prepared to ask about the points that you brought up.

Thank you very much!

- Lou

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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center
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Wonderful advice

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