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Shooting pains around the big toe

Do you have shooting pains around the big that radiate forward from the side of the big toe joint into the big toe? If you do, then you might have what is called a Joplin’s Neuroma.

There is a nerve (the medial plantar digital nerve) the goes over the side of the big toe joint. This nerve can have a lot of pressure on it if you have a bunion or use tight fitting footwear. This irritation of the nerve can lead to the formation of a neuroma, the Joplins Neuroma.

The typical symptoms are a shooting and radiation pain over the joint and into the big toe.

The treatment approach to this problem is to get the pressure off the irritated nerve. This will involve wider fitting footwear and the use of padding to keep pressure off the joint. If those measures are not helpful, then a surgical removal of the neuroma might be needed.

If you have any shooting pains around the big toe joint, them come in and see us and we should be able to help.

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What is a Tailor’s Bunion

A Tailor’s Bunion is the bunion that occurs at the base of the little toe. It is called a Tailor’s bunion because it used to be assumed that it was more common in the Tailor’s who used to sit cross legged while they did their work. This sitting position put a lot of pressure on the outside of the foot wear this small bunion occurs. It is also called a bunionette as it is widely considered to be the smaller cousin of the typical bunions that occur at the base of the big toe.

The cause of a Tailors bunion is most likely die to poorly fitting footwear causing pressure on the fifth toe in those who a hereditary predisposition. The symptoms are an enlargement of the bone at the base of the first toe that may become inflamed and be painful when wearing shoes that press on it.

To treat a Tailor’s bunion make sure you are wearing roomy, comfortable shoes with a wide toe box can alleviate pressure on the painful area and provide relief. Barefoot can be best or something like the Archies will allow you to walk around without any pressure on it. Any shoe that puts any pressure on the joint are best avoided. High heel shoes will also increase the pressure on the problem and are best avoided. There are protective pads and corrective pads can help reduce friction and protect the affected area. The pads can be placed on or around the enlarged joint to straighten the toe and protect the bunion for friction.

If these approaches with good shoes and different paddings are not helpful, then surgery is really the only other option to get rid of a Tailors bunion.

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Do you need toe straighteners?

Toe straighteners or toe correctors or toe spacers or toe braces or correct toes or whatever you want to call them are being used more often than in the past. They come in a variety of different designs and types with a lot of variation between them.

The purpose of these toe straighteners are to obviously straighten the toes! As you can see above, the left one tries to straighten them by pulling down on the toe from above whereas the one on the left tries to straighten and separate the toes to spread them. This spreading is particularly helpful if you spend all day in tight footwear. As to which toe straightener you should use, it could depend on the nature of the problem that we are trying to correct. The one on the left will also fit better into the shoes whereas the one on the right will only fit into shoes that have the room. It may be better to use the one on the right as more of a night splint.

The main use for these toe straighteners are to use on toes that are cramped into shoes all day. They are helpful for hammer toes and claw toes and the one on the right can be particularly useful for conditions like a Morton’s neuroma.

At the end of the day, if you wear shoes, you will probably benefit from one or both of these types of toe straighteners to counter some of the forces that the shoes apply to the foot to deform them. Get in touch with us if you want more advice on this.

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If your big toe hurts to move, then we need to find a way to stop it moving

Pain in the big toe that hurts when walking is most commonly due to osteoarthritis, a condition commonly known as hallux rigidus (if the joint is really stiff) or hallux limitus (if its not so stiff). If its really painful at rest, then it might more likely be gout than hallux rigidus. With the hallux rigidus, when we are walking and the heel starts to come off the ground, the big toe joint needs to move. If that movement is limited or there is osteoarthritis in the joint, then that is going to be painful to walk. It makes sense that if that joint hurts to walk, then a logical way to deal with it is to restrict how much the joint moves.

There are a number of ways to do this. One is felt padding that can be stuck on the foot under the big toe and ball of the foot or strapping could be used to tape the joint. Both of these are really good short term measures. If you need a foot orthotic for other reasons, there is an extension that can go on the front of the orthotic called a Morton’s extension that can be used to stiffen up the joint. Another way is to use a carbon fibre insole plate that usually are about 1-1.5mm thick and very rigid that fit inside the full length of your shoes. These carbon fibre plates are often used to treat hallux rigidus and other problems such as turf toe. The evidence is that they are pretty effective.

Another way to treat the pain from the hallux rigidus is to simply use shoes that are more rigid across the ball of the foot. The more flexible the sole of a shoe is, the more that the big toe joint is going to move and the more likely it is to be painful. The are some shoes, especially the Hoka running shoes, that have a rocker built into them. The effect of the rocker is that the big toe does not need to move as much. A pedorthist or shoe technician can add a rocker on the sole to many different types of shoes to achieve the same thing.

If you have pain in your big toe joint when you walk, come and see us and we can discuss what options may be the best for you.

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How to protect a bunion in tight fitting footwear?

Sometimes you just have to do what you have to do. When you have a bunion the advice that podiatrists are going to give you are going to be to make sure that your footwear is of an adequate width in the forefoot so as not to push on the bunion or push the big toe over further. You will probably get some advice on some exercises that you could do to help keep the toe mobile and flexible. You will be given some education about the cause of the bunion being a combination of hereditary factors and poor fitting footwear and the importance of getting the right footwear for a better long term outcome. You may even get admonished at a follow-up visit if you are not following the advice. There may also be a discussion of different types of pads that can be used to relieve pressure over the bunion and different ones that you can wear in your shoes to make them more comfortable if they are painful. You will probably have a discussion about the surgical options for bunions and how different surgical techniques can be done and just what is the recovery time following bunion surgery.

But sometimes (or maybe often) you find yourself in a position where you have to wear or use the shoes that you have just been told are not good for your bunions, or even worse, you have to wear tight fitting footwear for some sort of special occasion. The world is not going to end if you do that occasionally, but it is going to be a problem for your bunion if you do it a lot. What can you do if you find yourself in that position and need something to get you through to help protect the foot and maybe even prevent future problems? There are some options that maybe you might want to try to help you get through the very short term use of the wrong footwear. One of these products that we often advise patients to use is the Bunion Assassin or similar products. These are a sleeve that goes around the forefoot and between the first and second toe. In between the toes it has a silicone pad that puts a gentle separation between the toes to put it in a more correct position. It also has some silicone gel that goes over the bunion to protect it from shoe pressure to make it more comfortable. The Bunion Assassin is not going to fix your bunion, it is however, going to make it more comfortable and perhaps make those shoes that you really should not be wearing more tolerable. Additionally, if you do end up wearing those wrong shoes very occasionally, you could consider the bunion corrector night splint that will go a little way to undoing some of the damage that the shoe might have done. Also after a night out in those wrong shoes you know you should not be using, do some exercises to mobilise the joint.

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What is the difference between a hallux valgus and a bunion?

Sometimes the terms that get used medically, hallux valgus (or hallux abducto valgus) and bunions are used to describe the same thing when they aren’t.

A bunion is the enlargement that occurs on the big toe (hallux) joint, or technically the first metatarsophalangeal joint. Hallux valgus is when the big toe angles in a valgus direction, which is towards the outside. There is debate about if this is valgus or abductus (hence the term hallux abducto valgus and which one occurs in which direction, but that can wait for another day).

Basically, a bunion is the lump and the hallux valgus is the deformity.

So, yes they are not the same thing, but a bunion almost always occurs with a hallux valgus and they are both parts of the same problem.

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Can the ‘bunion correctors’ actually correct a bunion?

These are splints or braces that you are supposed to wear at night and are claimed by those who sell them to correct the bunion (or more appropriately called ‘hallux valgus’). If you look at the pictures of them, it is easy to see how they might do that. The question then becomes, do bunion correctors work?

Thinking about the physics and biomechanics, it is easy to see how the brace could try to correct the position of the toe during the night. The only problem with that thought is that the next day you have all the forces of weightbearing and the footwear pushing the toe back the other way. It is probably likely that those forces easily overcome any correction that may have occurred over night, at least theoretically.

What does the actual evidence say? One study has shown that they do actually work. They showed an improvement of a few degrees after a few months of use, which seems a good outcome. However, what the study did not show (and no other study has looked at) is that if there is any more improvement if it is used for longer or if the improvement is maintained if use of the bunion corrector is stopped. Based on this it is hard to give advice on if the bunion correctors do work at improving the angle of the big toe. That does not stop a lot of people asking if they work in forums and Q & A groups online.

Having said that, that does not mean that they do not have there uses. However, that use often has to be combined with the use of exercises and footwear advice. They can be particularly helpful at increasing the mobility of the joint and that can have a significant impact on the ‘aches and pains’ coming from inside the joint that can be common in those with bunions. We do have these available if you think you would benefit from them and please do not hesitate to contact us if you have any issues with bunions.

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