We don’t think about our toes much, but they are the appendages that make all of our daily movement possible. We cram them into ill-fitting shoes, forget to trim their nails, and generally don’t pay attention to them. That is, until toe pain makes them impossible to ignore.
Why do my toes hurt when waking up, or at the end of the day?
If you wake up in the morning thinking, “Why does my toe hurt?” you’re not alone. Toe pain can occur anytime, even when you aren’t active or standing up. For some people, throbbing big toe pain becomes so intense at night that it wakes them up. For others, toe pain begins when they are on their feet all day.
You might also feel toe pain when you:
- Are active after a period of rest
- Participate in vigorous activity
- Try a new sport or hobby that involves different movements in the feet
It may seem obvious, but toe pain does not feel that same for everyone. Some people experience it as sharp and stabbing, while other describe it as burning and constant. You might feel toe pain that shoots across the ball of your foot, down through the instep, or up between the toes.
In addition to toe pain, some people also feel pain in the top of the foot, down to the heel, and up the leg. Every experience is different and depends largely on your unique toe pain causes.
What causes toe pain?
Some of the more common toe pain causes include:
- Ingrown toenails
- Cuts or scrapes
- Athlete’s foot
- Plantar warts
- Small injuries (such as bruising from stubbing your toe)
While many people experiencing toe pain will find relief from allowing a blister or an injury to heal, sometimes toe pain can point to larger underlying issues.
These more significant causes of toe pain include:
- Toe or foot fractures
- Overuse injuries and strain, such as hammer toe and tennis toe
- Morton’s neuroma
- Peripheral diabetic neuropathy
- Arthritis, including rheumatoid arthritis and gout
- Bone spurs
Let’s look at these in more detail.
Toe or foot fractures
Stubbing a toe or dropping something on the foot can lead to toe and foot fractures. In some cases, there is no treatment except rest for this type of injury.
Overuse injuries and strain
Overuse injuries and strain, including plantar fasciitis, are some of the most common causes of toe pain. In some cases, imbalances caused by favoring an injury in one part of the body can actually lead to toe pain and foot injury as the body compensates.
Infection from ingrown toenails, unhealed wounds, and any other injury to the feet can result in big toe pain (and toe pain in general). People with diabetes in particular need to be attentive to injuries to the feet, as slow-healing wounds can have disastrous health consequences.
Morton’s neuroma is the name for thickening tissue surrounding a nerve in the ball of the foot, usually between the third and fourth toe. This feels like standing on a pebble and can result in sharp pain in toes.
As with other joints in the body, the joints of the feet have bursa, or small fluid-filled sacs that ease movement. When these bursae thin or burst due to injury or wear, the bones of the joint rub together, causing painful inflammation.
Peripheral diabetic neuropathy
Peripheral diabetic neuropathy is a condition where the nerves in the body are damaged by poorly controlled diabetes. This can lead to sharp pain in toes and other places in the feet.
There are over 100 forms of arthritis. The most common forms that lead to toe pain are osteoarthritis, rheumatoid arthritis, and gout.
Osteoarthritis is a wear-and-tear condition that generally worsens with age and use. This can also be exacerbated by incorrect balance in the body that leads to uneven wear.
Rheumatoid arthritis occurs when the body’s immune system attacks the joints, including the joints of the feet. This is a common cause of big toe pain that can make movement unbearable.
Gout is a less common form of arthritis that is caused by a build-up of uric acid in the joints. This build-up generally occurs in joints that are farther away from the heart—in this case, the big toes.
If the base of your big toe is swollen and painful after a long day on your feet, or even after a period of rest, you might have bunions. This type of toe pain is made worse by poorly-fitting or tight shoes and can eventually send your big toe under its neighbor.
Bone spurs are one example of the body trying to heal itself a little too enthusiastically.
When bones begin to wear down (sometimes due to osteoarthritis or imbalances), the body begins to generate more bone. If more bone is generated than needed, a callous begins to develop in the area surrounding the bone, causing pain when pressure is applied.
Diagnosing toe pain
Diagnosing toe pain may be as simple as identifying the injury that caused the broken toe, or it might be more involved.
You can start by tracking the pain symptoms you’re experiencing. This helps your doctor figure out the cause of your pain. As noted above, Morton’s neuroma feels like there is a small stone under the foot. Hammer toe creates visual symptoms—typically causing the middle toe joint to bend upwards. Both of these lead to toe pain, but in different ways. They also have different treatment approaches.
Start by tracking:
- Where you feel the pain: Do you feel pain in one specific toe, a toe joint, or between the toes?
- What the pain feels like: Is it sharp or shooting, or achy and throbbing? Did it come on gradually or was it sudden?
- If there are any visual symptoms: Do you notice any redness or swelling around the toes, large deformities on the toes or foot, or signs of infection?
- When you feel symptoms: Are you more likely to experience pain or other symptoms in the morning, while exercising, or while wearing specific shoes?
- Which treatments help: If resting or icing your feet, or taking your shoes off, relieves pain, make sure to mention that too in your tracker.
If there is no clear cause of the pain, your doctor will conduct a complete physical examination that includes checking your range of motion and taking a full medical history. They may also order a series of imaging diagnostics, including an X-ray and MRI to see if the bones or soft tissues of the feet are injured.
Finally, if no conclusion is reached by physical examination and imaging, your doctor may order bloodwork to rule out any systemic concerns.
Toe pain treatments to find relief
How you go about treating your toe pain will largely depend on what’s causing your pain in the first place. Some of the most common toe pain treatments—from simple interventions at home to surgery—include the following.
Making changes to your diet and exercise
Sometimes sharp pain in toes is simply a result of lack of activity. As with other parts of the body, if we don’t get enough activity, the feet become stiff and sore. Getting enough regular exercise and switching to an anti-inflammatory diet should be the first steps in preventing and healing toe pain.
Lose weight to reduce pressure on feet
Our feet support the full weight of our body with over 100 muscles, 30 joints, and 26 bones per foot. Make that job a little less stressful on the feet by maintaining a healthy weight.
Take breaks from standing
This may not be possible for you, but if you can, try to avoid standing for long periods of time. Get off your feet and sit for a few minutes periodically.
Elevate your feet
If/when you do get time to sit down and take a pause, try to keep your feet raised. This will help combat inflammation and prevent swelling.
Wear comfortable shoes
Choose shoes that are not too tight, are well-cushioned with shock-absorbing soles, and include arch support. For some people, this also includes avoiding high-heeled shoes as much as possible.
Look for toe-friendly shoes that feature a wider width at the ball of the feet to avoid toe pain that can develop from hammer toe and bunions.
Invest in some orthotics
Orthotics are inserts for your shoes that add extra support and cushion. If you have high arches, you may need a little extra arch support. If you have heel spurs, you may need some extra heel cushioning.
Orthotics come in a wide range of sizes, configurations, and prices, and are available at pharmacies, through your podiatrist’s office, or at shoe stores.
Choose your socks wisely
If you wear socks, make sure they’re cotton, versus made of a synthetic material.
Cotton will let your feet “breathe,” allowing moisture to evaporate and keeping your feet dry.
Use the RICE method for injuries
An easy mnemonic to remember the best course of action during an acute injury, RICE means to rest, ice, compress, and elevate the painful or injured area.
For feet, this might mean putting the feet up with a cold compress after a long day. If your feet are swollen after a day’s work, it’s best to soak them in cool to cold water to reduce the swelling and minimize pain.
Soak sore feet in a warm bath
On the other hand, soaking feet in a warm bath loosens stiff, sore joints. It can also help facilitate movement in the toes.
Indulge in a foot massage
Massage alleviates knots and tension in your aching feet. You can also do a self-massage for your feet.
Even if you can’t enjoy regular foot massages, you can do daily foot exercises. Flex your toes, point your toes, and rotate your feet and ankles.
Wear toe, foot, and ankle braces
When you break a toe, sometimes the only treatment is what is known as a “buddy tape.” Your doctor tapes the broken toe to a neighboring toe.
This is just one type of a brace-like support for the feet and ankles after an injury occurs.
Take over-the-counter medications, like aspirin or ibuprofen
Over-the-counter medications may relieve toe pain and allow you to proceed with other treatment options. Non-steroidal anti-inflammatory drugs also help relieve inflammation to make you more comfortable.
Visit a physical therapist to work on stretching and strengthening
Although toes and feet are not filled with large muscles, the smaller muscles in the feet and the muscles of the calves can benefit from physical therapy.
Physical therapy for toe pain will help to stretch and strengthen the support muscles while lengthening and stabilizing tendons and ligaments in the feet.
Acupuncture uses hair-thin needles inserted at specific points in the body to stimulate a healing response in the brain. Traditional Chinese medical doctors believe that these needles also free blocked energy in the body. This blocked energy, they believe, is the cause of disease and pain in the body.
Acupuncture for foot pain can help in many cases.
Consider epidural steroid injections
For treatment-resistant toe pain (and other foot pain, including pain on top of the foot), epidural steroid injections may help.
These injections contain an anesthetic to ease pain and a steroid to calm inflammation in the foot. A benefit to this type of injection is that they allow you to begin therapy and other treatments that pain prevented before the injection.
Talk to your doctor about surgery
There are a variety of surgical interventions that are possible when more conservative treatments are not successful.
- Bunion surgery: This can be a simple realignment of the toe or involve removal of the bunion
- Surgery to remove bone spurs: Excess bone is removed to prevent callouses
- Arthrodesis: This surgery removes damaged cartilage causing big toe pain and adds plates in the toe for support
- Hammer toe surgery: This straightens and corrects hammer toe to prevent worsening of the condition
- Morton’s neuroma surgery: This procedure removes the painful nerves in the ball of the foot
- Plantar fasciitis surgery: Plantar fasciitis surgery releases the tight plantar tendon to provide relief
Because recovery time can be extensive and surgery is considered invasive, your doctor will most likely only pursue surgery as a treatment after all other options have been exhausted.
Get help for toe pain
Toe pain can make even the easiest parts of our day challenging, but there are treatments that can provide relief. If you are experiencing toe pain that wakes you up in the middle of the night or forces you off your feet during the day, it’s time to get some help.
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