Like the thumb, the great toe is an important organ in the human body. The five toes in each foot starting from inner to outer side in a standing position are named as great toe, second, middle, fourth and little toe.
The great toe like in the case of thumb has two phalanges. The front one is called the distal and the back one the proximal phalanx when the foot is in a standing position. The distal phalanx forms the metatarso-phalyngeal joint with the first metatarsal giving the great toe greater flexibility frontward and backwards and slight movements sideways and rotational as well.
The great toe has rich nerve and blood supply and any problem with the blood supply will lead to movements becoming dysfunctional. Several conditions can affect a great toe. Most of the common great-toe injuries that affect active people are self-limiting and can be easily treated if only they are detected early.
Some of the common conditions affecting the great-toe in brief are:
- Hallux Valgus
- Turf Toe
- Halux Rigidus
- Sesamoid Dysfunctions
- Nail Abnormalities
- Dislocations & Fractures
It is important to remember that great-toe injuries are common in sports persons. They are particularly common in dancers, runners and football players. The encouraging part of these injuries is that most of these conditions can be treated conservatively which enables patients to return to routine activity relatively quickly. However, a continuing disability needs referral to an orthopedic surgeon.
Without proper diagnosis and timely treatment coupled with adequate rest the part affected for healing, these injuries can interrupt a person’s exercise program and severely limit the movements affecting the daily activities.
Here is a brief description of these conditions to help understand the importance of how to avoid their occurrences and attend to them when present.
Hallux Valgus: Involves the metatarso-phalangeal joint leading to deviation of the first metatarsal joint inwards and the proximal phalanx outwards. The commonest cause is the use of high fashioned shoes by the women folk. Other causes include hereditary factors, flat foot (where there is no arch) and hyper-elasticity of the joints. Conservative treatment is the cornerstone though operative procedures are available but prone to complications like stiffness. Modifications in the shoes may help.
Turf Toe: This is due to hyperextension of the great-toe. The term was originally used when most of the times football players injured their toes while playing on artificial turfs. Rest, ice compressions and elevation of the foot are the cornerstones of conservative treatment.
Hallux Rigidus: This is a painful progressive loss of motion of the metatarso-phalangeal joint. The cause for this is usually due to trauma while playing football and also during ballet dancing requiring excessive weight on the toes. Rest to the part and ice compressions and pain killers like NSAID’s are very helpful.
Sesamoid Dysfunctions: These small and round bone-like structures glide under a tendon and help in reducing the friction during movement of toes. When affected, they give rise to severe pain. Avoiding the use of high-heeled shoes and use of J-shaped pad gives great relief.
Toe Nail Abnormalities: Ingrowing of a toe nail though a minor ailment may disable an active person if not treated early. It occurs most commonly in athletes. Improper cutting of nail is another common cause. Gentle elevation of the ingrown nail and trimming it gives instant relief. One should always avoid tight fitting shoes. Soaking the toe in warm saline gives some relief.
Subungual Hematoma: This common condition usually occurs when someone suddenly steps on the great toe. It also occurs due to sports injuries. Compressions and keeping the toe dry and washing it with a lotion will help reducing the pain. Dislocations and Fractures: This happens as a result of a violent force as seen when forefoot strikes an immovable object or while trying to block a football against an opponent’s attempt to strike. In these conditions, orthopedic help is a must.
Plantar Calluses: These are hyperkeratosis lesions primarily located under the head of the metatarsal bone for the great toe. Karatolytic ointment gives relief.
Blisters: These are common with most athletes who wear shoes for a long time resulting from friction between the toe and the shoe. When the blister is big in size it needs to be punctured and the resulting wound dressed with antibiotic care.
Gout is one of the medical conditions that affects the toes in general and the great toe in particular. It starts with the great toe and then affects other toes. Treatment with anti-gout drugs gives relief, if detected earlier.