Big Toe Pain and Running: What Runners Need to Know

November 6, 2024

This is a guest post from Stuart Goldfinch at Functional Movement Physio, Liverpool’s leading Sports Physio and Sports Injury Clinic

Big toe pain might seem like a small issue, but for runners, it can be a real setback. That little joint does a lot of work, helping to propel each stride and absorb shock with every step. When pain flares up in the big toe, it can sideline your training and disrupt your running rhythm. If you’re experiencing big toe pain or hoping to avoid it altogether, here’s what you need to know about common causes, symptoms, and ways to keep your toes happy and pain-free.

You can also read more on my website if you’d like to know more about big toe pain and running.

Why Runners Get Big Toe Pain

Running is a high-impact activity that requires strong, resilient feet—and the big toe plays a big role. Here are some of the most common reasons runners develop big toe pain:

Hallux Rigidus (Stiff Big Toe)
If your big toe feels stiff and sore, especially when pushing off, you might be dealing with hallux rigidus. This form of arthritis affects the big toe joint and can make it hard to bend. For runners, this can lead to difficulty with push-off and a change in gait to compensate, which can cause other issues down the line.
Bunions (Hallux Valgus)
Bunions are more than just a bony bump—they shift the alignment of the big toe joint, which can lead to pain, especially during long runs. Tight shoes or genetics can make bunions worse, pushing the big toe toward the second toe and causing inflammation and tenderness along the joint.
Turf Toe (Big Toe Sprain)
Turf toe is a sprain of the big toe’s ligaments, often from overextending or suddenly pushing off with too much force. Common in sports with quick pivots, it can also affect runners, especially those who run hills or do speedwork. If you’re feeling pain, swelling, or bruising around the base of your toe, turf toe could be the culprit.
Sesamoiditis (Pain Under the Big Toe)
Sesamoiditis is an inflammation of the sesamoid bones, which sit under the ball of your big toe. These tiny bones help the toe move and bear weight, but they can get inflamed from overuse or repetitive stress—common in runners, especially if you’re upping your mileage or changing your routine.
Gout (Sudden, Intense Pain)
Gout is a type of arthritis caused by a buildup of uric acid crystals in the joint. Though less common among younger athletes, it can affect anyone and often targets the big toe with sudden, intense pain. For runners, a gout flare-up can make any movement excruciating and may require medical intervention to manage.

How Big Toe Pain Impacts Running

Big toe pain can throw off your entire running form, forcing your foot to compensate by altering its alignment. Over time, this can lead to pain in other areas, like the ankle, knee, or even hip. Push-off power and stride efficiency also suffer, so addressing the issue early can keep your training on track and prevent further injuries.

Managing and Treating Big Toe Pain for Runners

When it comes to treating big toe pain, runners need solutions that allow for continued training while protecting the toe. Here are some tried-and-true strategies:

Rest and Modify Training
Rest is key for many types of big toe pain, especially turf toe and sesamoiditis. You don’t necessarily have to stop running altogether, but reducing your mileage, avoiding hills, and switching to lower-impact activities like swimming or cycling can give the toe a break.
Switch to Proper Footwear
Shoes with a wide toe box, good arch support, and cushioning can help reduce pressure on the big toe. Some runners benefit from shoes with a stiffer sole to limit painful bending of the toe. Custom orthotics or padded insoles may also help by redistributing pressure and providing added support.
Ice and Anti-Inflammatories
Ice therapy can reduce swelling and relieve pain after a run, while over-the-counter anti-inflammatory medications, like ibuprofen, can help manage inflammation. Applying ice for 15-20 minutes, especially after a long or intense run, can ease discomfort and speed recovery.
Toe Strengthening and Mobility Exercises
Strengthening the muscles around your big toe and improving its mobility can help prevent recurring issues. Try exercises like towel scrunches (using your toes to pull a towel toward you), toe curls, and big toe extensions. Stretching and foam rolling your calves and feet can also help keep the entire foot and toe complex flexible and strong.
Consider Medical Interventions
For runners with chronic big toe pain or conditions like gout, consulting a medical professional can open up more options. Injections of corticosteroids can relieve pain and inflammation in the joint, while medications can manage uric acid levels for those with gout. In severe cases, such as advanced hallux rigidus or problematic bunions, surgery may be considered to realign or stabilize the joint.

Preventing Big Toe Pain: Tips for Runners

Prevention is key, especially for runners who put extra strain on their feet. Here are some tips to help keep big toe pain at bay:

Choose Shoes Wisely: Look for shoes that fit well, with ample room in the toe box and adequate support. Avoid shoes that are too tight or have narrow toes, as they can worsen bunions and create unnecessary pressure.
Warm Up Properly: A good warm-up can make a big difference, especially if you’re hitting the trails or doing hill work. Include dynamic stretches and mobility exercises that target the foot and toe.
Increase Mileage Gradually: Sudden increases in distance or intensity can overload the big toe joint, leading to issues like sesamoiditis. Following a gradual training plan reduces the risk of strain.
Listen to Your Feet: If you feel a twinge or ache in your toe, don’t ignore it. Taking a short break, reducing mileage, or trying supportive footwear early on can help prevent a small issue from becoming a bigger problem.

Wrapping Up

Big toe pain doesn’t have to sideline your running for long, but addressing it early can save you from more serious issues down the road. Whether it’s a stiff joint, a painful bunion, or a mild injury, there are plenty of ways to manage the pain and keep your feet healthy. As always, if the pain persists or worsens, consider reaching out to a healthcare provider to help tailor a treatment plan to your needs and keep you on the path to pain-free running. Happy trails!