Persistent Pain Between Toes: Causes and Treatment Options

Pain in the joints of the second and third toes on the dorsum of the foot?

Hello Dr.
Chen: I have swelling and redness between the 2nd and 3rd toes on my left foot, and I experience pain while walking.
I don't recall any external injury occurring the day before the pain started.
A month ago, I had an X-ray taken, and the orthopedic doctor said there was no issue with the bones and that it was likely just general inflammation, suggesting that I rest more.
I have switched to wearing sneakers to work, applied anti-inflammatory ointment, and soaked my foot in warm water (if I soak my foot the night before, the pain is somewhat better the next day).
However, a month has passed, and the pain has not improved.
What could be the possible causes? Which specialty should I consult? Thank you for taking the time to respond amidst your busy schedule.

Xiao Sha, 40~49 year old female. Ask Date: 2020/09/20

Dr. Chen Yongxue reply Orthopedics

Hello, based on your description, it seems to be a common case of plantar fasciitis.
This condition is often seen in individuals who have jobs that require prolonged standing or walking.
Typically, it requires rest, heat therapy (as you mentioned that heat therapy has improved your symptoms), and massage.
If the symptoms persist for an extended period, a local corticosteroid injection may be considered for relief.
Thank you.

Reply Date: 2020/09/20

More Info

Persistent pain between the toes, especially when accompanied by redness and swelling, can be quite distressing. Given your description, it seems that you have already consulted with an orthopedic doctor who ruled out any bone issues through X-rays and suggested that it might be a case of inflammation. However, since the pain has persisted for over a month despite conservative measures, it is essential to consider other possible causes and treatment options.

Possible Causes
1. Soft Tissue Inflammation: Since the X-ray did not show any fractures, the pain could be due to inflammation of the soft tissues, such as tendons or ligaments, around the toes. Conditions like tendinitis or bursitis can cause localized pain and swelling.

2. Gout: Gout is a type of inflammatory arthritis that can cause sudden and severe pain, redness, and swelling in the joints, often affecting the big toe but can also involve other toes. It is caused by the accumulation of uric acid crystals in the joints.

3. Morton's Neuroma: This condition involves a thickening of the tissue around a nerve leading to the toes, often causing pain, tingling, or numbness between the toes. It is commonly seen between the third and fourth toes.

4. Metatarsalgia: This condition refers to pain and inflammation in the ball of the foot, which can radiate to the toes. It can be caused by various factors, including improper footwear, high-impact activities, or foot deformities.

5. Infection: Although less common, an infection in the toe area could lead to redness, swelling, and pain. This is particularly relevant if there is a history of injury or if you have any underlying conditions that may predispose you to infections.

6. Nerve Issues: Conditions affecting the nerves, such as peripheral neuropathy, can also lead to pain and discomfort in the toes.

Recommended Actions
Given that the pain has not improved with rest and topical anti-inflammatory treatments, it would be advisable to take the following steps:
1. Consult a Podiatrist: A specialist in foot and ankle conditions can provide a more thorough examination and may order additional imaging studies, such as an MRI or ultrasound, to assess soft tissue structures that X-rays cannot visualize.

2. Consider Blood Tests: If gout or other inflammatory conditions are suspected, blood tests to check uric acid levels or inflammatory markers may be helpful.

3. Physical Therapy: A physical therapist can help with exercises to strengthen the foot muscles, improve flexibility, and reduce pain.

4. Footwear Assessment: Ensure that your footwear provides adequate support and cushioning. Sometimes, orthotic inserts can help alleviate pressure on specific areas of the foot.

5. Medication Review: If you are using anti-inflammatory medications, discuss with your doctor whether a different class of medication or a stronger prescription might be necessary.

6. Rest and Ice: Continue to rest the affected foot and apply ice to reduce swelling and pain.

Conclusion
Persistent pain between the toes can arise from various causes, and while inflammation is a likely culprit, other conditions such as gout, Morton's neuroma, or even infections should be considered. Since your symptoms have not improved, seeking further evaluation from a podiatrist or a rheumatologist may provide more insight and lead to effective treatment options. It is essential to address this issue promptly to prevent further complications and improve your quality of life.

Similar Q&A

Persistent Pain Between Toes: Seeking Solutions for Ongoing Discomfort

Hello Doctor, I used to stand for long periods at work, which often caused my feet to be very sore. Most of the soreness and pain would return to normal after a period of rest, but the area on the dorsum of my right foot between the little toe and the ring finger continues to hav...

Dr. Jiang Junyi reply Neurology
Hello, Miss 0w0: Your symptoms are clinically referred to as "allodynia" and "hyperesthesia," which are manifestations of sensory hypersensitivity. Clinically, in addition to physical therapy, certain medications can also help alleviate the symptoms. Furthermo...

Understanding and Managing Pain Between the Toes: Causes and Solutions

Dear Dr. Hsu, I have been experiencing intermittent pain between the second and third toes of my right foot for the past couple of months. Initially, the pain occurred about once a week, but in the past week, it has escalated to several times a day, sometimes waking me up at nig...

Dr. Xu Zhenrong reply Physical Fitness
Dear Ms. Chris, Based on your description, the cause of your foot pain may be due to inflammation at the pressure points on the soles of your feet while walking. Generally, inflammation in the plantar region tends to be more pronounced when weight is applied, and the pain may le...

Understanding Recurrent Toe Pain: Causes and Solutions

Hello Dr. Jiang, since the end of last year, I have been experiencing intermittent sharp pain between the 3rd and 4th toes on my left foot. Sometimes it occurs 5-6 times within an hour, and other times it happens once every 2-3 days. Although the pain is not very intense, it is s...

Dr. Jiang Junyi reply Neurology
Dear Ms. Ying, You mentioned that "the area between the 3rd and 4th toes on my left foot experiences recurrent cramping pain, sometimes occurring 5-6 times within an hour, and other times only once every 2-3 days. Although the pain is not very intense..." Poor blood ci...

Chronic Pain in Right Second Toe: Causes and Treatment Options

Hello Doctor, the information above pertains to my mother. She has been experiencing pain in her right foot's second toe for nearly 40 years, with no interruption, only varying in intensity. The pain is described as a sharp, shooting pain that can radiate from the toe up to ...

Dr. Gao Chunde reply Neurology
It may be worth considering a rare condition known as "leg pain toe movement syndrome," which was previously reported by Taipei Veterans General Hospital. You can search for it online. The related diseases and underlying mechanisms are still somewhat complex, but there ...