This information is not a definitive list but only a guide to possible causes of your pain which can be helped by your physiotherapist. There are a wide range of medical conditions that can cause your pain. An assessment by one of our physiotherapists will allow them to take a detailed history and perform a thorough examination to give a diagnosis. They can then treat you effectively or recommend a medical referral if it is required.
PAIN IN THE BIG TOE
Hallux Valgus (bunion)
This is a condition in which the big toe begins to bend towards the little toe, away from its ideal position. The cause of Hallux Valgus is often unknown but inappropriate footwear may be a cause. As the joint bends it can affect the other toes that can lead to pain in either the big toe or smaller toes. This is due to the change in muscle pull and joint position. A bony lump may also appear on the inside of the joint and this can rub on shoes; this is called a 'bunion'.
Your physiotherapist can offer guidance and advice on appropriate footwear and orthotics to reduce your symptoms. We can prescribe you strengthening exercises to prevent further displacement of the joint and reduce symptoms. Techniques such as acupuncture and TENS can be used to reduce the symptomatic pain from the condition. If your physiotherapist feels surgery may be required we are able to recommend top London foot and ankle consultants to review you. After surgery physiotherapy is very important to restore full movement back into the big toe.
Hallux Rigidus (stiff big toe)
The normal movement of the big toe joint is in an upward and downward direction (dorsiflexion and plantarflexion). When the normal movement is reduced or restricted it is called Hallux rigidus. The stiffness may be caused by arthritis in the toe joint and this may be painful. The joint may develop a bony overgrowth, normally a 'bump' on the top of the joint called an osteophyte. This osteophyte may be painful as it blocks dorsiflexion of the joint. This is normally worse with running or walking. As the arthritis increases, the joint stiffens. Treatment options vary depending on the level of deformity and stiffness in the joint.
Your physiotherapist can use techniques such as mobilisations to reduce stiffness, give you exercises to improve the arch strength and muscular support and advise you on appropriate footwear and possible orthotics to reduce your symptoms. If your physiotherapist feels a corticosteroid injection or surgery may be required we are able to recommend top London foot and ankle consultants to review you.
Osteoarthritis
Other joints of the big toe can become arthritic with age, after trauma (e.g. stubbing the toe) or excessive periods of poor positioning. This causes outgrowths of bone around the joint called osteophytes and this can become painful.
Treatments such as acupuncture, mobilisations and TENS can be used to reduce the pain. Strengthening of the foot muscles and correct positioning of the joint with orthotics and footwear advice can be useful in reducing symptoms also. If your physiotherapist feels you need a medical review we are able to recommend top London foot and ankle consultants.
Referred pain
Pain can be referred into the big toe from the lumbar spine and L5/S1 spinal nerve. This occurs because irritation and compression of these nerves causes pain in the associated area that they supply and the brain gets confused by the signals, sending pain to the area served by the nerve. This pain is commonly burning in nature, diffuse and can be accompanied by pins and needles or numbness in the area.
Your physiotherapist will be able to exclude any local structures as the cause of your pain and will assess the nerve health and mobility. If this diagnosis is reached then successful treatment can include specialist nerve mobility exercises, release of the tissues affecting the normal nerve movement and treatment to the low back if appropriate to ease your symptoms.
Gout
This condition commonly affects the joints of the big toe but can occur in other joints in the body. It presents as hot, swollen, red and tender joints that appear inflamed. Gout is relatively common and on the increase and although the actual cause is not commonly treated by conventional physiotherapy methods, those who suffer from it commonly have altered walking patterns because of the pain and so may benefit from rehabilitation as well as advice on techniques to reduce the swelling. Physiotherapists can also offer advice on appropriate exercise to improve health without adding unnecessary stresses to the big toe joints.
Vascular conditions (diabetes)
Pain in the foot can be due to changes to the circulation and blood supply to the tissues. This could be due to diabetes or other conditions that reduce the circulation, leading to reduced blood flow or damage to the lining of the blood vessels. Vascular pain is commonly described as aching in nature and you may see skin changes such as altered colour, swelling and increased small veins.
Your physiotherapist can identify and assess whether your pain is likely to be due to vascular pathology and can advise you on the appropriate treatments for you. You may need advice on exercises to improve your circulation, reduce swelling or to improve your overall health in order to reduce the risk factors for conditions such as diabetes. They will inform you if they feel further medical review of your condition is required.
1st MTP (big toe) joint sprain
This can happen if your big toe is forced into bending backwards and can lead to the capsule around the joint and the ligament of the joint being damaged. Often there will be some pain and swelling at the joint which is worse when putting weight on the foot and moving your big toe.
Physiotherapy can help to reduce the inflammation around the joint and tape your toe and foot to offload the joint. Stiff soled shoes are often recommended to give more support for a few weeks after injury and to recover normally takes about 3 weeks.
Joplins neuritis
There is a nerve that supplies the skin over the 1st toe and this can become compressed and irritated giving pain along the big toe.
Orthoses can help and changing footwear and foam put into the shoe to take pressure of the nerve.
PAIN IN THE TOES
Morton's neuroma
This condition is caused by irritation or entrapment of the small nerves between the toe bones. The nerve can become painful causing burning pain or numbness it the area. This most commonly occurs between the 3rd and 4th metatarsals (foot bones). This condition can be due to tight fitting shoes, or poor walking pattern but can also be bought on by unknown cause
Your physiotherapist can assess if this is the cause of your foot pain, advise you on appropriate footwear for your condition, and use taping to offload the tissue or acupuncture to relieve the pain. Sometimes appropriate stretches and strengthening exercises to improve your biomechanics can offer relief of symptoms. If they feel a medical review is required we can recommend top London foot and ankle consultants to you.
Ingrowing toenail
Acute pain develops within the toenail and often the nail can become infected. The condition normally arises from the nails growing abnormally or poor toenail cutting. With this condition it is best to see your doctor or chiropodist.
Metatarsalgia (synovitis of the MTP joints)
This condition refers to pain in the long toe bones of the foot. It is commonly caused by hallux valgus or hallux rigidus of the big toe (explained above). Change to the positioning and joint movement of the big toe has a knock on effect on the movement and positioning of the other toes. This can lead to inflammation and pain over the joints, most commonly the 2nd and 3rd toes are affected. Sometimes this leads to noticeable alteration to the position of the toes if left untreated.
Physiotherapy can offer pain-relieving modalities such as acupuncture and taping techniques plus guidance on appropriate footwear and pacing of activities. We can also offer advice on strengthening exercises if the biomechanics have been altered significantly and this can sometimes have a positive effect on the pain from metatarsalgia. If your physiotherapist feels you need to a medical review we can recommend top London foot and ankle consultants to you.
Fractures
Fractures can occur in the long bones (metatarsals) of the foot with overuse activity, trauma or high impact or to the small bones within each toe. Sometimes these fractures can occur with osteoporosis if the bones are weakened. This type of pain can be severe and persistent if not identified and treated early.
Your physiotherapist will be able to fully assess your risk of fracture after injury and advise you on the appropriate treatment options in line with best practice. If a fracture is suspected they will recommend a review with a top London foot and ankle consultant who may recommend you have a plastercast, supportive boot or shoe to support the fracture site while it is healing. With time you may have a limitation of movement and stiffness due to this. Physiotherapists can utilise mobilisation, massage and specialist stretching techniques to regain your full movement and return to full function after this injury. We will progress your individual exercise programme with you, ensuring the rehabilitation is fully tailored to your individual needs and sports.
Toe clawing
This can occur when the tendons of the muscles that bend your toes become tight and become like a claw which can give pressure on certain points of the toes and pain.
Physiotherapy can help by working on releasing the tightness of the tendons and teaching you exercises to stop the clawing at home. If a medical review is required we can recommend a top London foot and ankle consultant to you.
Referred pain
Pain can be referred into the toes from the lumbar spine and L5/S1 spinal nerves. This occurs because irritation and compression of these nerves causes pain in the associated area that they supply and the brain gets confused by the signals, sending pain to the area served by the nerve. This pain is commonly burning in nature, diffuse and can be accompanied by pins and needles or numbness in the area.
Your physiotherapist will be able to exclude any local structures as the cause of your pain and will assess the nerve health and mobility. If this diagnosis is reached then successful treatment can include specialist nerve mobility exercises, release of the tissues affecting the normal nerve movement and treat the low back if appropriate to ease your symptoms.
Rheumatoid Arthritis
Rheumatoid Arthritis is when the immune system goes haywire and attacks the body rather than defending it causing inflammation of the lining of the joints and tendons of the muscles. In both conditions joints in the body that have the arthritis become swollen, painful and stiff. Morning stiffness on waking is very common. Muscles around the joints often become weaker and doing certain activities of daily living can become more difficult.
We can provide experienced physiotherapists to see you at home and work with you to help manage your condition. The first time the physiotherapist visits they will carry out a thorough assessment that includes looking at your mobility and walking aids, muscle strength, joint movement, posture and function.
Following the assessment the physiotherapist will discuss any treatments they can provide and set goals with you to improve your general function and mobility and achieve the maximum potential in your home, work and social life. These treatments can include advice on ice, exercise programmes, massage, taping, acupuncture and mobility programmes.
We can also provide occupational therapists to come to your home. They help people to regain the ability to carry out activities that have purpose and meaning to them and become or remain as independent as possible. Some of the services they can offer include:
- Home assessments including modifications such as rearranging furniture, building ramps, widening doorways, grab bars, special toilet seats etc
- Wheelchair assessments
- Splinting
Chronic Pain
Acute pain is the pain we feel immediately after injuring ourselves and while the injury is healing. Chronic pain is pain that continues even though healing has occurred and it is not unusual to find no direct link between the pain and the original injury that may have healed a long time ago. Chemical changes happen in the brain and spinal cord to re-route signals to pain centres in the brain. Then any normal sensation such as a movement, touch, pressure, stretching etc can be felt as pain. In some instances the pain system can be activated without any physical stimulus ie changes in weather, mood, thoughts or no stimulus at all.
Physiotherapy for chronic pain has to involve many aspects and address other factors that come into play rather than just the pain itself. They will treat the pain and also use methods to help you manage your pain including advice on pacing and coping with flare ups and negative thoughts, graduated exercise programmes and goal setting. They will aim to return to you being able to participate again in activities you were involved in before developing chronic pain whether work, sport of hobby related. We can also recommend top London pain consultants to help you.
Other possible causes
Your physiotherapist will take a detailed history of your symptoms and past medical history before performing a full physical examination. There are a number of other possible causes of your symptoms which are not appropriate for a physiotherapist to treat in any way or that need a medical opinion alongside physiotherapy treatment. In this case they will recommend you to your GP or an appropriate specialist doctor or specialist consultant. These possible causes include:
- cardiovascular symptoms
- respiratory (breathing) symptoms
- gynaecological symptoms
- urinary or genital symptoms
- digestive symptoms
- immune system symptoms
- lymph system symptoms
- hormonal symptoms
- neurological symptoms
- dermatological (skin) symptoms
- medication side-effects
- virus
- infection
- cancer
- disease process
- psychological problem ie. depression, anxiety
CONTACT US NOW FOR A PHYSIOTHERAPIST TO COME TO YOU
