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The response to the question below was authored by Marc Mitnick DPM
nerve pain in my right big toe when I point my toe downward
by Christopher
(Santa Cruz, CA)
For the past few weeks I have been experiencing sharp shooting pain in my right big toe, that extends from the base of the toe up to the tip and is isolated on the outer side of the toe. I have no issue whatsoever when walking and normally don't even notice any pain. However, I do notice sharp shooting pain if I point my toe downward when my leg is fully extended, or if I put even moderate pressure in a particular spot near the base of my big toe. When pressure is applied in that spot, I feel the pain shoot all the way up my toe. Also, if i lightly touch my toe along the line of pain, I notice reduced sensitivity, like almost very light numbness to the skin, but the harder I push the more it hurts.
I recently saw a podiatrist and he took xrays and said everything looks pretty normal. He said there was a slight bump at the joint at the base of my toe but it was not severe. His conclusion was that something was irritating my nerve and that is what is causing the problem but didn't really offer any solution other than changing my shoes, or doing a cortisone injection. I have been wearing the same shoes for some time and they feel perfectly fine to me and I do not notice any rubbing or irritation in that spot on my foot from the shoes. It's been several weeks with the pain, and
RESPONSE
Hi Christopher,
The most common cause of your symptoms is usually a local irritation of one of the nerves that goes into your toes, in this case your big toe.
Think about it. When you bend your foot downward you are essentially stretching all the structures on the top of the toe. What happens is the affected nerve then gets pressed against the bony structure of your toe and the nerve then gets irritated, so it begins to hurt.
Sometimes this can be caused by a shoe whose toe box is not high enough, so your podiatrist was right in mentioning that possibility. However, you state your shoes do not seem to be an issue.
Basically this becomes an issue of how badly it bothers you. If it is more an observational finding and does not cause you discomfort, then live with it. Over time it may calm itself down and one day you will notice it has resolved.
On the other hand, if you find it painful or annoying to the point where you are constantly thinking about it, then I would recommend a cortisone injection. Assuming you have no contraindications for cortisone, it is a simple injection that just goes under the skin at the level of nerve irritation in an effort to reduce the nerve inflammation.
Marc Mitnick DPM
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