Big Toe Area Pain: Years after Healing Sesamoid Injury

Hi Richard,

I wanted to write to you because of pain in my big toe that has been bothering me for the past few weeks (about 5 weeks). Unfortunately, this pain is fickle and elusive, and very hard to describe.

My history:

- turf toe and sesamoid AVN in 2019-2020, which I recovered from thanks to your wonderful blog

- I was walking perfectly fine for a ~6 months

- played tennis one day and had pain the next day in my big toe, but a different one than I'd had before - it hasn't gone away unfortunately

The pain:

The pain is sometimes very sharp when I put weight on my foot right after getting up, but then immediately subsides. At first it felt like "pins and needles", but now it hurts more "traditionally". I can't tell where exactly my toe is hurting, but it definitely hurts when I press in the webbing between the first and second toe. My joint clicks a bit (though when it does, it is painless), and to be honest I can't remember whether it did that before feeling the pain or not. Moving my big toe doesn't hurt, I have full range of motion, my sesamoids seem fine. It occasionally hurts when I compress my first phalanx with my hand, I think it's called the "proximal phalanx of the big toe". Overall the pain tends to be better in the morning, and worse after a whole day of walking.

Please let me know if you have any leads, because I admit I'm quite perplexed by my current condition!

May God preserve you and your family in this difficult time. 

With all my consideration

Dr Blake’s Comment: Thanks for your email and glad the sesamoid AVN finally healed and you were back to good activity. Some of the symptoms are definitely nerve, like the pins and needles and pain that comes on and disappears quickly. In your case, it could have just be the body trying to tell you that something is amiss that needs protection. Your original injury was to the big toe joint. Previous joint injuries tend to pop up from time to time. Like you are doing now, you have to take them seriously, but they represent that the joint is not perfect. Imperfect joints (for me they are the left ankle, right knee, low back, and right shoulder) from old injuries are generally alittle stiffer (so they can get jerked easier) and the body’s reaction is quicker (from nerve memory). 

     So, what does this all mean? Typically, we are not dealing with anything serious if the range of motion is normal and there is no swelling, black and blue, or redness. Also, it is a great sign that there are times of the day that it does not hurt at all. These aggravations of old injury areas need to be treated seriously since this joint is a weak spot for you. The 3 areas to address are mechanics, probably spica taping or bunion toe separators to start, inflammation (so icing and contrast bathing once or twice daily), and nerve hyper-sensitivity (neural flossing with non painful joint motions, and non painful massage for 2 minutes twice daily. This should be done for 2 weeks, and then based on the response, either lessen your treatments or increase them in some way. 

     I hope this makes sense. Rich