Our big toe is a frequent site of foot pain, because of injury. That is why gout attacks are most frequent here.
Acute gout is an archetypal acute inflammation, a red, hot, painful swelling with loss of function. In a severe case, you can't walk, stand on it or even bear the bedclothes on it
This big toe pain can wake you from sleep.
If this is your first attack ever, it may be difficult to tell if it is gout or an infection or possibly a severe reaction to sting by an unnoticed insect.
One can have a fever and be a little unwell, from a gout attack as well as from an infection. Look for an skin injury here, where germs could have gained access.
Untreated attacks of gout last a few days.
That's a long time, if the pain is severe.
As to colchicine v. indomethacin v. prednisolone - whatever agrees goes.
If you are already taking the preventative drug allopurinol, it is really important not to stop it during an attack, as this can prolong the attack.
My naturopath friend would think first of boswellia and devils claw, but emphasized that the next step would be prevention.
If you have gout and are over weight, you would for all intents and purposes lose the gout by getting back to a healthy weight.
The herb gravel root has a similar effect to preventative drugs.
The only way to prove⁹ any inflammation is due to gout is to aspirate fluid and see urate crystals under a polarized light microscope. Blood tests can never prove it, but are worth doing a few weeks after the attack has settled, as very high levels of urate are cardiovascular and kidney risk factors.
More persistent big toe pain and loss of function, can be due to hallux rigidis.
Can you wiggle your big toe up and down? In this condition it's stiff at the first joint.
An X-ray will show osteoarthritis.
Stretching the tight joint capsule here, requires some force. I rest the persons' foot on a wooden step, first joint at the edge. I then lean heavily on the toe beyond the edge, attempting to shift the whole toe down - keeping it straight out, not swinging it down.
Nasty treatment, but gives some relief of this foot pain.
Ingrown toenails can be pretty painful too. Nail clippers don't get to the edge of a tightly curved nail, leaving a little spike when the cut nail is ripped off here. The spike digs into your flesh and infection follows.
It's either more pain as the spike is cut off, or more pain as local anaesthetic is injected before this. Prevention is starting to sound pretty good.
The edge of a toenail is very smooth and soft. It should poke out a little at the end of our toes - just a little, not enough to wear holes in our socks. This means cutting toenails more square across than is often done.
A pad on the side of the toe, a little back from the tender area, can keep pressure from the shoe or next toe off same.
Infection under toenails needs "deroofing." If the toenail is thick, opaque and dirty yellow colored, it is likely infected with tinea.
If it is sore and there is a little moisture under the edge, it is likely there is bacterial infection.
It is common enough to end up with both these infections at once.
In either case, the first and often only treatment needed, is to cut away all of the nail which is no longer attached to the flesh of your nail bed. I've had several surprises over the years, finding a large area of the nail separated from the nail bed by a hidden collection of pus.
There is no point putting terbinafine cream on, unless the tinea infected nail is cut away first.
Hallux valgus with bunion can also get quite inflamed and painful at times.
This condition involves splaying out of the ball of the foot due to weakness of the small intrinsic muscles.
This in turn is due to not digging our toes in as we leave each foot behind, walking.
Shoes keep the ends of the toes together, so the toes end up pointing in towards each other. They can also end up this way purely from the bowstring effect of the long tendons, as the metatarso-phalangeal joints spread apart.
The famous athletics coach Percy Cerruty used to have his elite middle distance runners train in bare feet on the sand hills at Portsea. To get traction in sand, you have to use the intrinsic muscles.
Next best exercise for these little muscles, is just walking with conscious effort to dig your toes in as you leave each foot behind (repeat of above, for emphasis.)
Last but not least, have an inch thick piece of wood for toe exercise. Turn both feet in so as to have all your toes on board. Use your toes to grasp the edge of the wood. Then attempt to lift your body weight on your toes.
You will feel the lumbrical and interosseous (intrinsic) muscles working in your foot, when you attempt this.
Foot pain problems don't happen nor get fixed, overnight. You need to continue this exercise for months.
Soft corns are localized painful thickenings of the skin at the side of a toe. They are softer than callouses on the sole of our feet because of the moisture between toes.
Both are caused by our skin there, being the "meat in the sandwich" - between a bone under the skin on one side, an exterior hard surface on the other.
I guess the skin thickens up as a protective measure, but the thickening just increases the pressure. If you feel the adjacent toe directly opposite a corn, it's bone is obvious there. This is the "external hard surface" in this case.
Why a corn forms on one side only, I don't understand.
You may be able to remove the thickened skin by getting under the edge with a fingernail, a bit at a time over a few days. Your podiatrist will happily cut it off painlessly and without drawing blood.
Blessed relief of foot pain.
Padding between the toes concerned will also relieve the pain. It needs to be placed just back from the tender area, so as to hold the two toes apart there.
Tinea pedis or athletes foot between toes is mostly itchy, but can get painful splits at times. Thick white skin builds up between the toes, in this fungal skin infecion.
The scaling rash can spread out onto the skin on top or under your foot, but if it is tinea dermatophytosis, it will always be between toes as well.
An antifungal cream containing the drug Terbinafine is really good. Calendula (Marigold) is a herbal which is very effective, usually applied as a lotion.
Other topical treatments mentioned include aloe vera, grapefruit seed extract, lactobacillus acidophilus, neem oil, oregano oil, propolis, tea tree oil and vitamin C powder. Lactoferrin supplements orally also get a mention. I don't have the experience to comment on these.
This can be a medical emergency, if it hasn't happened to you before. Your foot pain may mean a major artery in your leg needs to be unblocked.
On the other hand it may be chilblains (pernio), in cold weather.
Here the toes are swollen and dusky red, even ulcerated.
Intense irritation increases going from cold to warm environment.
Tight footwear presses the blood out of the skin and prevents our body heat from getting there.
The best treatment is walking a lot.
A woman patient recounted to me the cure for her bad chilblains.
Her husband bought racing greyhounds, and she exercised them daily, walking many miles quite rapidly.
There was no trace of the chilblains and she had never felt better in herself.
Australians have their Rawleighs ointment. South Africans have their ZamBuk.
Nifedipine may be prescribed and is good - but ensure you get the original Adalat oros brand.
This is a plastic capsule with a tiny hole in one side to let moisture in to push the nifedipine out another hole on the other side.
Side effects are less frequent with this formulation.
Dr. Schuessler's biochemic cell salts can be usefull. These are homeopathic preparations of 12 common salts in our body. Calc. phos. is the main remedy for chilblains. For others see below.
Vitamin K 4, (acetomenaphthone or menadiol diacetate) 5mg by (painful) intramuscular injection or 10mg bd or tds orally, was reported¹ to be very effective.
When I first started in practice, a preparation named Vipernic was available and I heard good reports about it. It was 5mg acetomenaphthone + 25mg nicotinic acid (Vit B3.) The recommended dose was 1-3, three times a day. Pernivit was an equivalent product in UK.
Vitamin K4 is synthetic, appears to be still manufactured, but I can't find anything on current human products. It is not the same as MK4, which is a form of natural vitamin K2.
Nifedipine is a calcium channel blocking drug and the main functions of vitamin K are at Gla domains involved in binding calcium.
All these last three foot pain treatments therefore involve manipulating calcium metabolism.
Hot and cold foot baths as advised in Dr. H.C.A. Vogel's "The Nature Doctor" also work.
The feet are soaked in hot water for 2-3 minutes, then in cold water for 2-3 seconds, and this sequence is repeated 6 to 8 times per session. He advises to end with cold water, then towel vigorously and rub in a little oil (preferably St.John's wort oil.)
If you already know that you have blocked leg arteries responsible for cold, discolored toes and foot pain, massage may help - but don't put off vascular surgery if this is advised.
This is similar to the gentle rotary massage used in lymphoedema. You need to massage every bit of the skin, including between your toes. Spend about 1/4 hour per foot.
Buerger-Allen exercises involve raising the limb till white, then lowering it till red, repeatedly. I have no experience re these, but can't imagine they could do any harm. I would try them and see if they helped one's foot pain.
Cold extremities are not usually due to blocked major arteries. The common reason is facet joint fixation in the appropriate part of the spine (when one's back or neck is "out.")
Women particularly, may have cold extremities without anything obvious as a cause.
Like other causes of peripheral neuropathy, diabetes can cause toe and foot pain, numbness or tingling.
Even with pre-diabetes (impaired glucose tolerance,) one can already have a painful sensory neuropathy before the underlying sugar problem has been diagnosed⁵. It is important to pick this up, because aggressive diabetic control and lifestyle interventions can delay the onset of diabetes and may reverse small-fiber neuropathy associated with early diabetes mellitus.
The usual medical treatment for this pain includes drugs such as duloxetine, pregabalin, amitriptyline and opioids.
Capsiacin cream may help this foot pain...
"More than 50% found that it helped to bring some relief. It may make things feel more burning for the first few days, but after that there is an improvement."
Alpha lipoic acid has been tested in a double blind study², and found effective. It was given in large doses intravenously, but for a very short time (3 weeks.) A later study used doses by mouth over a longer period³
See reference below⁴ from the Linus Pauling Institute, regarding this.
Sometimes too rigid control of blood sugar can aggravate foot pain in diabetic neuropathy - there's a happy medium probably, as poor control definitely worsens it over time.
Hyperbaric oxygen therapy is apparently of proven benefit in diabetic foot ulcers complicated by gangrene or osteomyelitis, so it's reasonable to assume it might help earlier stages (but not proven.)
While on the subject of diabetic foot ulcers, there are a few reports of speeding up healing with topically applied insulin (as well as one I saw of this causing a hypoglycaemic attack.)
I've only one patient with this foot pain complaint and I haven't been able to help her.
Looking through some websites on foot problems, the only one I found with decent material on it , was...
Apart from the usual run of drugs, two suggestions I saw were wrapping the feet in Opsite (with the skin under some tension,) and pantothenic acid tablets ( Vit.B5.)
Acupuncture can apparently help this foot pain.
Does it hurt when you try to gently bend the toe sideways – with a finger of your other hand against the other side of the toe further up, to prevent it just swinging sideways.
This is a reasonable way to tell if the toe is broken - when the attempt will be quite painful.
Your big toes have two, the rest have three joints and bones each. If the stubbed toe isn't too tender, you can squeeze along it between finger and thumb, to see where the worst tenderness is.
Tender joints may be sprained or just have a little bone edge broken.
A very simple splint may then give instant relief of pain. Use 6 inches of inelastic, hypo-allergic tape, 1 inch wide. Attach this from the tip of the stubbed toe, straight back underneath along your sole.
Fracture treatment apart from immobilization.
I have a distinct clinical impression that this protocol speeds up healing.
Maximum tolerated dose of vitamin E in first 24 hours, then cease.
This should be natural vitamin E rather than synthetic.
Two weeks later, calcium gluconate 10% slowly intravenously.
I remember one person with a fractured collar bone, who had this treatment and surprised his orthopaedic surgeon with the speed of his healing.
Victoria, where I live, had John Landy as our Governor. He was the Queen's representative, a great honor for the former elite athlete.
Percy Cerruty was his coach and has a wonderful story, which you can read at http://geoffmoore.blogspot.com/search?q=cerruty
This has nothing directly to do with foot pain (see above re the training method, running barefoot in sand.)
The ball of your foot houses the front end of the stout first metatarsal bone, which is often where we take off from, stepping.
It shouldn't be.
We should use the first toe, beyond it.
I know, I'm repeating myself again - a sign of age, or in this case of the importance of the message.
This bone forms the front part of the medial longitudinal arch of our foot. Looked at from the other foot, the weight bearing structure is roughly a triangle - this at the front, the heel bone at the back and the
plantar fascia across the bottom.
The plantar fascia helps to hold the bottom ends from spreading too much, and the leg muscles hold up the apex of the triangle.
This arrangement allows some give as we stand - it's not too rigid. It acts like a shock absorber.
The leg muscles concerned are Tibialis anterior and posterior, Peroneus longus and brevis. These are on the outer side of your leg and deep in your calf.
A fun way of keeping them strong is a
You can get circular ones as well as see saw ones.
Sorting out the site of tenderness is the first step to finding the cause of foot pain in this area.
Squeeze the metatarsal heads together sideways.
Push backwards along each toe, keeping the toe straight as you do it.
Find the joint on the inner side of your foot at the back end of the first metatarsal.
Holding the forefoot and heel, twist the forefoot on the heel with a rotary motion.
Rub along each metatarsal shaft.
Hold two adjacent toes at their bases and rub their metatarsal heads up and down on each other.
Squeeze each metatarso-phalangeal joint.
Stress fracture of a metatarsal shaft will be tender on the shaft and on twisting the whole forefoot and pushing up on that toe.
These were first described as "march fracture" in soldiers after route marches. They are a sign of osteoporosis.
Rheumatoid arthritis will be tender on squeezing the metatarso-phalangeal joints, individually or together sideways.
Swelling may not be very obvious, but there will be prolonged morning stiffness and pain. It is very important to pick up RA early, to avoid permanent joint damage.
In Mortons neuroma foot pain is produced by squeezing the metatarsal heads together sideways (especially if you squeeze between them at the same time,) and on rubbing one against the other.
This causes sharp shooting pains down the affected middle toes plus pins and needles and numbness.
This tender lump on a nerve is caused by pressure between dropped metatarsal heads, in the next condition.
In adolescence, Freiberg's disease⁸ may show on an X-ray
Next is probably the main reason for sore feet after being on them for longer than usual...
In foot pain from Arch weakness you will be tender over the joint at the base of the first metatarsal.
With firm pressure this joint is felt as a narrow groove, exactly half way back along the inside edge of your foot.
Press right on the groove and alongside it, to see which is more tender - on the joint, local cause; alongside it, referred pain from further up in your calf.
You may also be tender under the middle metatarso-phalangeal joints.
There may be tenderness and swelling behind the inner ankle bone (medial malleolus) due to tibialis posterior tendinopathy.
Now, under your forefoot may have a convex appearance, viewed from the front, with your foot off the floor. The anterior metatarsal arch should give it a concave appearance.
There may be calluses under these dropped metatarsal heads, which are a further cause of foot pain.
The toes are likely to be held up and tightly curved, instead of pointing straight forwards. This clawing of the toes is due to weakness of the "intrinsic muscles" of the foot, between the metatarsal bones.
Painful corns can develop on the top of these clawed toes, from pressure against shoes.
With your foot flat on the floor, roll it from side to side. "Pronation" is when your weight is on your big toe, little toe lifted off the floor.
"Supination" is when the weight is on your little toe and your big toe is lifted.
You will find these terms used a lot, in describing foot abnormalities. eg. flat foot = excessive pronation, when the real problem is the collapse of the medial longitudinal arch.
When you roll your foot like this, you should feel pressure under your big and little toes, but not in between - provided your anterior metatarsal arch is intact.
The exercises for this foot pain problem, are above under hallux valgus.
Padding is useful for immediate relief of foot pain when callouses are present.
A bigger truck needs more tyres on the road. Spreading weight reduces the pressure. Padding is needed beside a corn, not on it.
I pare down the corn with a surgical blade. The hard thickened skin feels like a splinter under the skin, to walk on. Removal gives immediate relief of this foot pain.
Plantar warts or papillomas look a bit like corns, but as successive layers of hard skin are sliced off the circular shape becomes obvious. There will be a cleft around the edge of the wart.
Small warts anywhere can be recognized by the sideways displacement of skin creases by the circular wart. Corns have the skin creases going uninterrupted, straight through them.
Warts are painful if they are on spots which get pressure as we walk. Corns are so too, and are always on such spots.
Application of a paste of vitamin C powder in oil from a vitamin E capsule, can be effective.
The Scheussler biochemic salt kali mur, can too, either orally of rubbed on the wart.
The inside of banana peel, taped over the wart overnight, can work.
Apply vinegar after soaking cut lemon in it for four days.
Petty Spurge (Euphorbia peplus) sap applied to the wart after painting the surrounding skin with protective nail polish, then covered with tape, is also effective.
Any method is likely to work quicker if you can slice off a bit of the top first. Between applications, if there is some softened wart on the surface, scrape it off.
Persistence pays off. Wart treatment can take some time.
A 10% solution of silver nitrate⁶ applied every other day, or a silver nitrate pencil⁷, is also effective often.
As well as the main remedy,
Kali Mur. and Ferr. Phos. can be alternated to help reduce the pain and swelling,
Calc. Fluor. for cracks in the skin,
Kali Sulph. if there is thin yellowish exudation.
You can have your own page on this site, be anonymous if you prefer, and help other people or get useful opinions.
1. Vitamin K4 and Chilblains. David P. Wheatley. Br Med J 1948;2:800
Acetomenaphthone or Menadiol diacetate, used in this study, appears to still be available in at least one tablet, Good Health's Supercal Bone Food.
2. http://www.ncbi.nlm.nih.gov/pubmed/9285502 Ziegler D, Gries FA. Diabetes. 1997 Sep;46 Suppl 2:S62-6.
3. Also, Ziegler et al gave 460 patients with mild to moderate diabetic peripheral symmetrical polyneuropathy, either alpha lipoic acid 600mg per day or a placebo for 4 years, and found those treated improved clinically whereas the placebo treated patients worsened. This quoted in DIABETES CARE, VOLUME 31, NUMBER 3, MARCH 2008
4. http://lpi.oregonstate.edu/infocenter/othernuts/la/ From the Linus Pauling Institute
5. Zilliox L et al Treatment of Diabetic Sensory Polyneuropathy. Curr Treat Options Neurol. 2011 Jan 28.
6. Ebrahimi S; Dabiri N; Jamshidnejad E; Sarkari B Efficacy of 10% silver nitrate solution in the treatment of common warts: a placebo-controlled, randomized, clinical trial. International Journal Of Dermatology 2007 Feb; Vol. 46 (2), pp. 215-7.
7. Yazar S; Başaran Efficacy of silver nitrate pencils in the treatment of common warts. The Journal Of Dermatology 1994 May; Vol. 21 (5), pp. 329-33.
9. A rule using male sex, previous arthritis attack, onset <1 day, joint redness, involvement of the first MTP joint, hypertension or one or more cardiovascular disease, and serum uric acid >5.88 mg/dl, is pretty good at picking gout. This was confirmed by comparing it with joint fluid examination in 219 cases. See rheumatology.oxfordjournals.org
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Domains are here part of protein molecules, made of chains of amino acids. "GLa domains" are the part of the protein where vitamin K forms gamma-carboxyglutamate, or GLa.