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Rheumatologist: Never Ignore Big Toe Pain — It Can Be the First Sign Of Underlying Disease

The 5 questions to ask yourself to determine your next (gentle) step

For such a small body part, your big toe can cause enormous pain — and when it wakes you in the middle of the night, the sensation is impossible to ignore. As it turns out, this type of pain is surprisingly common, especially when it occurs at night — and especially as we get older. As with many symptoms, it can be caused by a number of factors. So we asked top doctors who specialize in feet and joints just what a throbbing pain in your big toe can mean — and what you can do to ease the ache.

The good news is that whatever underlying condition is causing your toe pain, it is likely very treatable. But this type of pain often comes from a problem that requires medical treatment, sometimes even long-term treatment. Read on to learn more about this strange symptom.

Why does toe pain strike at night?

Why does the painful toe throbbing happen at nighttime? There are a few reasons, says Juan J. Maya MD, a rheumatologist at Rheumatology Center of Palm Beach and medical advisor to CreakyJoints: You’re likely lying down after a day packed with activity. As your body relaxes, you’re more likely to notice discomfort that you were able ignore during your busy day. “Nighttime is when your mind is kind of quiet,” he says. “It is when your brain has the time to focus on the toe pain.”

If you’re suffering from throbbing pain in your big toe, ask yourself a few questions to get a better idea of what’s causing the pain.

1. Do you have a fever?

A body temperature higher than 100 F suggests that you have an infection, such as an ingrown toenail or bone infection that requires urgent care. See your doctor sooner rather than later, encourages Dr Maya. For short-term relief, try soaking your toe in warm water with white vinegar or Epsom salts, suggests Robert Kornfeld, D.P.M. a holistic podiatrist with offices in New York City and Long Island. Treatment will depend on the cause of the infection, but it could involve antibiotics, pain relievers and removal of part of the nail or bone.

2. Is your big toe stiff and swollen?

Hallux rigidus is a type of osteoarthritis (OA) or age-related “wear and tear” arthritis that affects the big toe joint, also known as the metatarsophalangeal joint. With Hallux rigidus, “there’s so much wear and tear that the toe really doesn’t move much,” says Dr. Maya, noting that a doctor or podiatrist can help you manage painful symptoms with devices and treatments such as insoles (find the best ones here), injections, or surgery. Find a podiatrist near you via the American Podiatric Medical Association (APMA) or the American Board of Podiatric Medicine (ABPM)

For short-term relief, icing the toe may help if there is no infection, says Dr. Kornfeld. Click through for two additional natural approaches that relieve the pain of osteoarthritis.

3. Did toe pain come on suddenly and intensely?

A more complex form of arthritis, gout or gouty arthritis, causes severe attacks with pain, swelling and tenderness, often in the big toe joint. An inflammatory form of rheumatic disease, gout occurs when your body accumulates uric acid and sharp crystals form inside and around joints.

Pain from gout can be excruciating and is known to wake people from sleep. Compared to other toe pain related to arthritis, gout is usually episodic. “The ‘wear and tear’ arthritis happens more consistently,” notes Dr. Maya, “The more you do, the more you feel it.” Gout can be the opposite; surprise attacks can seem random, he says.

Your primary care doctor or a podiatrist can diagnose gout with lab tests that measure the levels of uric acid in your blood. They can prescribe pain meds in the short term, if needed, and get you on a treatment plan that will help prevent future flare ups and joint damage. You can also try these simple strategies to outsmart gout naturally.

4. Is it a burning or aching pain, and does it improve when you hang your foot off the side of the bed? 

You could have a vascular or circulation issue, says Dr. Kornfeld. Like osteoarthritis, peripheral vascular disease (PVD) is a slow and progressive disorder. Blockage in a blood vessel can cause PVD, also known as peripheral artery disease (PAD). When a blockage restricts blood flow to the tissue in your feet or legs, damage (and pain) occurs in the part of the body below the blockage. 

Hanging your feet off the bed or standing improves blood flow to the legs and can help relieve pain in the moment, but Dr. Kornfied notes that “a proper professional analysis and prescription plan is essential.”

Testing will help determine a treatment plan, which may involve reducing cardiovascular disease risk factors such as high blood pressure or high cholesterol with medication and lifestyle changes. These tips will also help ease PAD symptoms naturally.

5. Do you have a history of diabetes, stroke or neurological disease?

Sometimes, pain in the big toe is a neuropathic pain caused by a nerve disorder such as a compressed nerve or neuropathy. If your doctor suspects nerve involvement, she will want to rule out a Joplin’s neuroma (a compressed nerve between the big toe and second toe), Dr. Kornfeld says, adding that, if necessary, this neuroma can be treated with custom foot orthotics and various forms of injection therapies.

Peripheral neuropathy may be a result of nerve damage somewhere in the body. Symptoms can include weakness, numbness and pain in the hands and feet. To investigate, a doctor would use imaging or lab tests to help pinpoint the root source, such as diabetes, autoimmune disease, nutrient deficiencies or other causes).

According to Dr. Kornfeld, treatment depends on the actual underlying mechanism,” but often involves lifestyle tweaks like getting more activity and changing your diet. CBD might help too. And research published in the journal Medical Acupuncture suggests that acupuncture may help treat some types of neuropathic pain.

Click through for an amazing story about the power of lion’s mane mushrooms to cure neuropathy: “I Tried a Lion’s Mane Mushroom Supplement to Cure My Neuropathy—And It Worked!”

This content is not a substitute for professional medical advice or diagnosis. Always consult your physician before pursuing any treatment plan.

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