Pain in the Top of Foot When Lifting Big Toe: Causes and Solutions

When lifting the left big toe, there is pain on the dorsum of the foot?

Hello Doctor: I am a graphic designer who has been sitting in an office for a long time.
I usually wear flat shoes, sneakers, and casual shoes, and to keep my feet comfortable, I intentionally choose shoes that fit just right or are half a size larger.
However, a few days ago, my foot started to feel uncomfortable.
I would like to ask for your advice.
My symptoms are as follows: my toes move normally, but the other four toes do not move.
When I try to lift my big toe, I feel like I can't lift it, and there is pain on the top of my foot (specifically, there is a prominent vein on the top of my big toe towards the ankle that hurts), which even extends a bit towards the inner side near the ankle.
What confuses me the most is that when I step down while walking, it does not hurt; rather, it is more painful when I lift my foot.
I have tried massage and heat therapy, which provide temporary relief, but after a few minutes of walking, the pain returns.
The pain is on the top of my foot, not the sole, and I have not been hit by any heavy objects, nor do I wear high heels.
In fact, it hurts more when I wear flip-flops.
This is really troubling, and I don't know what to do.
What could this condition be?

Yi Yi, 20~29 year old female. Ask Date: 2011/03/14

Dr. Shi Guozheng reply Orthopedics

There are many causes of pain in the big toe.
Since you did not describe any redness, swelling, or warmth, gout cannot be ruled out.
Additionally, if there is hallux valgus, the toe may bend outward and deform.
Inflammation of the periosteum or tendons can also cause pain.
It is best to visit a hospital and consult an orthopedic physician for an accurate diagnosis.

Reply Date: 2011/03/14

More Info

Pain in the top of the foot, especially when lifting the big toe, can be attributed to several potential causes, and understanding these can help in identifying the right treatment. Given your description of the symptoms, it’s essential to consider a few key factors.

Possible Causes
1. Tendonitis: The pain you experience when lifting your big toe could be due to inflammation of the tendons that control toe movement. The extensor hallucis longus tendon, which is responsible for lifting the big toe, may be inflamed due to overuse or repetitive strain, especially if you are frequently sitting and then suddenly engaging in activities that require toe movement.

2. Nerve Compression: Another possibility is that you may be experiencing symptoms related to nerve compression, such as tarsal tunnel syndrome. This condition occurs when the posterior tibial nerve is compressed as it passes through the tarsal tunnel near the ankle. Symptoms can include pain, tingling, or a burning sensation on the top of the foot, particularly when moving the toes.

3. Metatarsalgia: This condition refers to pain in the ball of the foot, but it can also manifest as pain on the top of the foot, especially if there is a biomechanical issue such as flat feet or high arches. Wearing shoes that do not provide adequate support can exacerbate this condition.

4. Stress Fractures: Although less common, stress fractures in the bones of the foot can cause localized pain, especially during movement. This is particularly relevant if you have recently increased your activity level or if you have a history of osteoporosis or other bone density issues.

5. Capsulitis or Joint Issues: Inflammation of the joint capsule around the metatarsophalangeal joint (the joint at the base of the big toe) can lead to pain when lifting the toe. This is often associated with conditions like bunions or hallux rigidus.

Suggested Solutions
1. Rest and Ice: Since your symptoms seem to worsen with activity, it’s crucial to rest your foot and apply ice to reduce inflammation. Ice can help alleviate pain and swelling, especially after periods of activity.

2. Footwear: Evaluate your footwear. While you mentioned wearing comfortable shoes, ensure they provide adequate arch support and cushioning. Avoid shoes that are too tight or lack support, as they can exacerbate foot pain.

3. Stretching and Strengthening Exercises: Gentle stretching of the foot and ankle can help relieve tension in the tendons. Strengthening exercises for the intrinsic muscles of the foot can also improve stability and reduce pain.

4. Orthotics: Consider using custom orthotics or over-the-counter arch supports to provide additional support and alleviate pressure on the affected areas of your foot.

5. Physical Therapy: If the pain persists, consulting a physical therapist can be beneficial. They can provide targeted exercises and treatments to address the underlying issues contributing to your pain.

6. Medical Evaluation: If your symptoms do not improve with conservative measures, it’s advisable to seek a medical evaluation from a podiatrist or orthopedic specialist. They may recommend imaging studies, such as X-rays or MRIs, to rule out fractures or other structural issues.

Conclusion
Pain in the top of the foot when lifting the big toe can stem from various causes, including tendonitis, nerve compression, or joint issues. By understanding these potential causes and implementing appropriate self-care strategies, you can work towards alleviating your symptoms. However, if the pain persists or worsens, a professional evaluation is essential to ensure proper diagnosis and treatment. Remember, early intervention can often lead to better outcomes and a quicker return to your normal activities.

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