For such a small joint the 1st MTP joint (between the big toe and the rest of the foot) has a very important role in foot function. During the propulsive phase of walking the 1st MTP joint is extended backward as we move up onto our forefoot just before toe-off, adequate movement in this joint is crucial in allowing the foot to progress from heel to toe with ‘straight-line’ mechanics.

Extension of this joint also places tension on tissues underneath the foot (plantar fascia) which help to lift the arch of the foot and stiffen the forefoot (something known as the windlass mechanism) so that it functions as a rigid lever in order to enable effective propulsion.

Pain in the big toe is common and of varying causes.

Local foot pain may arise from the sesamoid complex which is composed of two small bones that sit under the big toe joint acting as a fulcrum for the tendons which bend the big toe downward, thus helping to stabilise the foot as we propel forwards. Because of their location they are susceptible to injury, either becoming inflamed (sesamoiditis) or even developing a stress fracture.

Injury to the sesamoid complex is generally due to direct trauma, either from a single significant impact to the region, or from repetitive microtrauma. A foot that over-pronates significantly or stiffness of the big toe joint can also predispose to injury to this region.

Treatment of sesamoiditis varies depending on the severity and could include shoe advice, the prescription of orthotic devices, and providing temporary cushioning of the region to give the sesamoid complex a ‘window of opportunity’ to settle. For those severe cases that require either corticosteroid injection or surgery we have relationships with leading foot surgeons.

Hallux valgus is a structural deformity of the big toe where the big toe progressively becomes angled inwards towards the second toe. A bursa then forms over the joint as a protective measure but often becomes inflamed causing pain and making the joint appear larger, i.e. a bunion. To learn more about this condition go here.

Ingrown toenails are where the side of the nail cuts into the skin next to the nail. The skin may also become infected or inflamed. Any toe can be affected, but the big toes are affected most commonly. To learn more about these go here.