Big Toe Joint Pain From Running

For runners experiencing pain in the joint of a big toe, the likely cause is hallux rigidus. A type of osteoarthritis, this injury can temporarily stop a runner's training regimen or, in serious instances, can mean a permanent end to running. Recognizing this problem early will play an important role in receiving early treatment and a gradual return to the track.

Close-up of runner's feet on pavement. (Image: trinaestipo/iStock/Getty Images)

Definition

Hallux rigidus is a type of arthritis caused by a wearing away of the cartilage that rests between the proximal phalanx bone, at the base of the big toe, and the first metatarsal bone of the forefoot. Each time the foot is bent, friction is caused between these two bones, gradually decreasing the toe's range of motion. This disorder usually develops between the ages of 30 and 60, however, it's unknown why some athletes develop the condition and others don't.

Causes

Hallux rigidus among runners starts with biomechanics of the foot. Runners who are flat footed or overpronate are most susceptible. Pronation refers to lateral movement of the foot from the point at which the heel strikes the ground to toe off during each stride. Overpronation is usually defined as a roll inward of 15 percent. Overtraining is also considered a cause of hallux rigidus. Other causes include simply stubbing the toe, gout or structural oddities in the bone structure of the foot. Genetics may also play a role in the onset of hallux rigidus.

Symptoms

In its early stages the condition is often referred to as hallux limitus. Symptoms may appear as limited mobility of the joint at the base of the big toe. Stiffness of the joint while moving, pain on top of the toe and mild swelling are often experienced. As the injury progresses, symptoms become more serious and include pain, even at rest; limping; bone spurs; and pain in other areas of the body, such as the knees and hips, as the afflicted person adjusts to compensate for the pain.

Treatment

Treatment of hallux rigidus usually starts with footwear. Wearing shoes that have a larger toe box decreases pressure and friction on the base of the toe. Stiff-soled shoes are also recommended. Other options for nonsurgical treatment include nonsteroidal anti-inflammatory drugs, physical therapy, orthotic inserts and coricosteroid injections for pain and swelling.

Surgical Treatment

In severe cases, surgery may be necessary to alleviate pain. Surgical treatments for hallux rigidus vary depending on the damage in the joint. Numerous x-rays are usually necessary to provide the physician with a detailed picture of the severity of the arthritis. Occasionally, more than one surgery may be necessary. A patient's activity level and age may also play a role in determining the best surgical treatment for hallux rigidus.

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