Runners tend to think about common injuries for large body parts like the knees, hips, and shins, but even an injury to your big toe can have a significant impact on your training.
Big toe pain running certainly isn’t as common as injuries to the knees or legs, yet some runners do end up sidelined from training due to one of several potential sources of pain in the big toe joint while running.
Whether you’re suffering from big toe pain while running or big toe pain after running, keep reading to learn about potential causes and treatment options for runners with big toe joint pain.
In this guide, we will cover:
- Why Does My Big Toe Joint Hurt From Running?
- Big Toe Joint Anatomy
- Is Big Toe Pain Running Common?
- Do You Have Big Toe Pain Running? Here Are the Possible Causes
- Risk Factors for Big Toe Pain In Runners
- Preventing and Treating Big Toe Pain Running
Let’s get started!
Why Does My Big Toe Joint Hurt From Running?
Although a relatively small joint compared to prominent joints like the ankles, knees, and hips, the first metatarsophalangeal (MTP) joint, which is the main joint of the big toe, is actually subjected to pretty substantial forces during every step of the gait cycle.
At ground contact, or heel strike, most runners land towards the outside of the heel. Your foot then pronates to help absorb the shock of landing.
As you pronate, your foot rolls inward and your arch compresses to accept your body weight.
As you transition in your running stride from your heel to your toe for push-off, the arch recoils back up and helps stiffen the foot into a rigid lever for a more efficient push-off.
Your weight then travels towards your big toe, which is the strongest toe, to optimize your leverage for push off.
Step after step, your big toe repetitively shoulders the burden of extending and propelling you forward into the flight phase of your stride.
Big Toe Joint Anatomy
Let’s just do an ever-so-brief anatomy lesson on the big toe for runners because it will help you understand why you might be having big toe pain running.
The big toe is actually more complicated than just a simple joint formed by two bones articulating at the metatarsophalangeal (MTP) joint.
There are also two small bones known as sesamoid bones (due to their resemblance to sesame seeds) underneath the MTP joint.
These tiny bones play the critical role of increasing the mechanical leverage of the tendons in your big toe.
In this way, the sesamoid bones in the big toe are akin to the patella (kneecap) in the knee, which increases the mechanical leverage of your quadriceps tendon.
Your big toe is subjected to very high forces during walking and running relative to the size of the joint, so these bones help multiply the force you’re able to generate through the extensor tendon in the big toe.
Unfortunately, the sesamoid bones themselves are fairly vulnerable to injury and even though their presence helps protect your big toe from injuries by increasing the mechanical advantage of the toe, the big toe joint is still prone to overuse injuries and overload.
Is Big Toe Pain Running Common?
Despite the fact that the big toe joint does play a significant role in your running stride, pain in the big toe joint running isn’t particularly common.
This isn’t to say that you can’t get big toe injuries from running nor does it eradicate the risk of suffering from pain in big toe running.
Moreover, foot pain is common in runners and most studies don’t lay out where exactly in the foot the pain occurs. According to research evaluating the incidence of musculoskeletal injuries in runners, anywhere from 5.7% to 39.3% of runners experience foot injuries.
Do You Have Big Toe Pain Running? Here Are the Possible Causes
There are several common potential causes big toe pain from running, including the following:
#1: Hallux Rigidus
Hallux rigidus, also referred to as “stiff toe,” is a term for degenerative arthritis specifically in the MTP joint of the big toe.
Due to the wearing away of the cartilage, you will feel stiffness and pain in your big toe joint.
The pain will be especially severe while running (particularly at push-off), though it can continue to hurt after your run as the condition progresses.
Pain will be worse when wearing minimalist running shoes or no shoes at all.
Unfortunately, this is a degenerative condition, so it’s not only more common in older runners, but there’s also nothing you can really do to reverse it.
#2: Functional or Structural Hallux Limitus
Hallux limitus refers to reduced range of motion in the big toe, so it is similar to hallux rigidus in terms of the consequences.
Structural hallux limitus is due to degeneration of the MTP joint of the big toe, while functional hallux limitus also results in limited movement of the joint but due to reasons other than joint degeneration.
Rather, the reduced motion is usually due to the joint being “jammed” repeatedly over time. This causes bony growth on top of the joint, which inhibits movement.
#3: Bunions
A bunion, referred to as hallux valgus, is a foot deformity wherein the first metatarsophalangeal joint (MTP) of the big toe juts inward (medially)while the toe itself points outward toward the second toe.
This deviation results in a prominent protuberance on the inner surface of your foot and alters the alignment and force that occurs during push-off when you run.
The migration of the MTP joint of your big toe makes the ball of your foot abnormally wide when you have a bunion.
This can then cause big toe pain when running because the MTP joint can chafe, rub, or be squeezed by the toe box of your running shoes.
Bunions can form from wearing tight shoes, or other causes of an imbalance between the extrinsic and intrinsic muscles of the foot, with some onus on the ligaments as well.
In a healthy foot, the proper alignment of the first MTP joint of big toe is maintained by the peroneus longus laterally, and the abductor hallucis muscle medially with collateral ligaments maintaining alignment from a rotational standpoint.
If tight shoes place pressure on the head of the big toe joint, the metatarsal starts to migrate such that the toe points towards your second toe and the base of the toe juts inward towards your other foot.
When this happens, the angle of pull changes in the muscles that normally align the big toe straight ahead.
The more and more the toe starts to migrate, the more the muscles pull it out of position because the mechanical advantage of the two opposing muscles becomes increasingly imbalanced.
In other words, the muscle that is pulling the base of the toe to protrude into a bunion gets into a continually better position to exert that adverse change, while the muscle that should be opposing this migration gets in a continually worse position to maintain proper alignment.
Moreover, over time, this migration of the big toe strains the medial collateral ligament and the medial capsule, until they eventually rupture.
In the healthy foot, these structures provide support along the medial surface of the foot. So, without them intact, the lateral structures (adductor hallucis muscle and collateral/lateral joint capsule ligaments) remain unchecked, further exacerbating the bunion.
Running in shoes with a tapered toe box increases the pressure on the MTP, and can start to force the big toe to point toward the other toes and conform to the tapered shape of the shoe.
Additionally, running in shoes with a large heel drop (meaning the heel elevated relative to the forefoot) puts more pressure on the forefoot and shortens the Achilles’ tendon.
This induces a compensatory flattening of the arch of your foot, which further increases the stress on the big toe and alters the alignment of forces going through your foot.
#4: Turf Toe
Turf toe is one of the more common causes of big toe joint pain running, though it’s particularly common in football and soccer players who play on turf.
Turf toe occurs when the big toe joint is rapidly and forcefully hyperextended, pressing your toe so that the tip points upward towards the sky.
According to the Cleveland Clinic, turf toe can result from a sudden extension of your big toe up to a 90-degree angle or it can occur from many repetitive movements over time (like pushing off too hard when you run).
Either situation sprains the ligaments of the big toe, resulting in swelling, bruising, and intense pain when running or walking.
In this way, the injury is somewhat like an ankle sprain, and you may be unable to run at all for a couple of weeks while the ligaments heal.
#5: Sesamoiditis
Sesamoiditis refers to inflammation of the sesamoid bones.
You will feel pain directly under your big toe joint, especially when you push against the underside of this joint rather than just flexing or extending the toe.
Pain is usually worse when walking barefoot.
#6: Sesamoid Stress Fracture
More severe pain under your big toe joint while running can be indicative of a stress fracture in one of your sesamoid bones.
This injury will require more extensive healing time and usually involves wearing a boot to immobilize the foot.
#7: Gout
Gout isn’t caused by running, but it can still result in big toe pain after running or during your run.
Gout is a metabolic condition characterized by the accumulation of uric acid crystals in a joint caused by the overproduction of uric acid.
The joint of the big toe is the most frequently-affected joint.
Gout attacks are often preceded by eating a rich, fatty meal and/or drinking alcohol.
Usually, your big toe joint will appear red and swollen.
Risk Factors for Big Toe Pain In Runners
There hasn’t been much, if any, research investigating the risk factors for big toe injuries in runners specifically.
However, given the common mechanisms underlying big toe pain from running, the following are likely to be potential risk factors for big toe joint injuries in runners:
- Midfoot striking
- Forefoot striking
- Being an older runner
- Prior traumatic foot injury
- Overtraining or insufficient rest and recovery
- Overstriding
- Overpronation or supination
- Tight calves and Achilles’ tendons
- Wearing tight shoes
- Running on grass or sand
- Excessive uphill running
- Gout, or diets high in fat and alcohol
Preventing and Treating Big Toe Pain Running
Once you’ve identified the most likely cause for your big toe joint pain running, you can start addressing the problem. Here are possible treatments for these various causes of big toe pain in runners:
#1: Replace Your Running Shoes
Worn out running shoes lack the support your foot needs to hold its form and absorb and transfer forces from impact to push off while running. Visit your local running shoe store to get properly fitted for new running shoes.
Consider zero-drop running shoes and shoes with a wide toe box if you’re suffering from bunion pain.
#2: Consider Orthotics
Overpronating can put excessive force on your big toe, which can lead to big toe pain running. Consider seeing a podiatrist or foot specialist for custom orthotics or try over-the-counter insoles for runners.
# 3: Immobilize Your Big Toe
If you have turf toe or a sesamoid stress fracture, you may need to immobilize your toe while it heals.
#4: Use RICE to Heal
The classic treatment for musculoskeletal injuries is RICE, which stands for Rest, Ice, Compression, and Elevation. Any of the aforementioned potential causes of big toe pain after running can respond to RICE, at least to some degree.
#5: Stretch Your Calves
Tight calves can contribute to bunions, and they may lead to landing on your forefoot, which puts more stress on your big toe. Spend time every day stretching your calves or using a foam roller.
#6: Stick with Easy Terrain
Flat, level roads are easier on your big toe joint than running uphill or running on soft surfaces like grass or sand.
#7: Ease Up On Your Training
Reduce your mileage by either taking time off or doing low-impact cross-training until your big toe joint pain resolves. More importantly, review your recent training to look for jumps in mileage or intensity.
#8: Seek Medical Care
If your pain persists, particularly if you are having big toe pain after running, seek medical care from your doctor or physical therapist.
For information on other foot injuries from running which include more than just your big toe, check out our guide, here.
