What Causes Big Toe Pain At Night & How It Can Be Treated?

There are a wide variety of causes for having big toe pain at night. The treatment for these also varies depending on the condition. Often you will arrive home from your day or sport and feel completely fine, then later out of nowhere your big toe may start to throb. This can occur due to delayed onset muscle soreness which is one of the many reasons for big toe pain.

What are the Symptoms?

Some symptoms you may experience at night in your big toe can include a sharp pain, a dull ache, burning or tingling sensation. Some people may also experience a cramping sensation in the big toe. Which symptoms you experience is dependent on the underlying condition present within the first digit. There can also be swelling/inflammation and limited movement/range of motion.

How Common is Big Toe Pain?

Big toe pain is extremely common as our big toe acts as our main lever during gait aiding us to push/propell of our feet. The development of first toe pain can be dependent on a range of factors. The natural position of your foot can place an increased load onto the first toe which can lead to the development of conditions such as bursitis.

What Causes Big Toe Pain at Night?

There are many conditions that can cause big toe pain, here are some of the most common ones:

Turf Toe

Turf toe can be easily defined as a sprain of the first metatarsal phalangeal joint. Typically this is a condition that will arise from physical activity where the toe is fully bent and jams up. Sports played on artificial turf and that involve jumping can increase the risk of suffering from turf toe. Turf toe can also be a chronic development rather than just a single moment of trauma. Typically you will notice swelling and a reduced range of motion at the big toe joint as well as a level of pain which is dependent on the severity of your injury.

Stubbed or Broken Toes

A broken, fractured or stubbed toe is easy to identify as we can identify a single moment of trauma where there is sudden pain, for example dropping a brick on your toe. They will typically all present the same way initially with swelling, bruising and a throbbing pain as well as a limited ability to move the toe. You may also see bleeding or a black nail.


Gout is a metabolic condition which impacts the body’s ability to remove uric acid from the bloodstream. Without the successful removal of uric acid, sharp crystals begin to form and deposit in and around joints, in our case, the big toe joint which is one of the most joints to see gout arise in. Gout can have a very sudden and aggressive onset of severe pain which occurs most commonly at night. Pain can be so bad that even the simple contact of the sheet against the toe can cause a great deal of pain. Typically it will present as shinny, red and swollen skin around the joint itself. Blood tests can be preformed by a primary care doctor to confirm developing gout.

Osteoarthritis and Hallux Rigidus

Osteoarthritis is the most common form of arthritis and results in the wearing down of the cartilage at the end of bones which happens slowly over time. This is the most common big toe joint pain. Once this cartilage wears down it results in bone on bone action at the joint. This bone on bone action, over time can lead to both pain and stiffness. This stiffness limits range of motion and the pain can be both whilst weight bearing and also at night. A common condition and the most frequently seen related to osteoarthritis in the big toe, is known as hallux rigidus. This occurs at the joint at the base of the big toe. Swelling is another frequently seen symptom of osteoarthritis.

Rheumatoid Arthritis

Rheumatoid arthritis is a chronic autoimmune and inflammatory disease. Those suffering are affected as their own immune systems attack healthy cells by mistake. Typically it attacks the joints of the body. It results in painful inflammation and joint stiffness.

Ingrown Toenail

Ingrown toenails are when the nail digs into the skin surrounding it. Depending on the severity of the ingrown nail, pain levels can range from minor to keeping you up at night. They can also become infected. Some signs and symptoms of an ingrown nail can include pain, tenderness, redness, inflammation, bleeding and exudate. If any of these signs are noticed you should see your podiatrist as soon as possible so the nail spike causing the pain can be removed and prevent it from getting worse.


Sesamoiditis is an overuse injury involving chronic inflammation of the tendons attached to the two tiny bones bones at the base of the big toe. The sesamoids act as a pulley system by providing a smooth surface for the flexor tendons to slide along thus allowing for an increased muscle force provided by the tendons. Common symptoms include bruising and swelling under the big toe. Pain will start off minimal but gradually get worse. There also may be issues trying to move the big toe.

Who Is Most Likely to Suffer from Big Toe Pain?

There are a variety of factors that can contribute to big toe pain. Those with a family history of arthritis are more likely to suffer from a form of arthritic pain within their big toe. Individuals who suffer from rheumatoid arthritis are extremely likely to suffer from some joint pain associated with their big toe. People who regularly engage in exercise and activity that involves jumping and pushing off your toes are also more likely to suffer from big toe pain. This is due to the increased load that is placed on the ball of the foot and in particular the first digit. Construction workers or others who work with heavy objects and equipment are also at increased risk to suffer from first toe pain due to trauma. Sports with bang bang moments like football also provide an increased risk of first digit trauma. Individuals with flat feet can also find their big toe hurts.

How Serious is Big Toe Pain?

Big toe pain can be serious but it depends entirely on the condition at hand as well as what stage that condition is in. Conditions like rheumatoid arthritis are very serious and chronic conditions that require assessment and treatment immediately. The level of pain you are experiencing is a good measure of how serious your big toe pain is. The more intense it is, such as keeping you up at night whilst in bed, would be considered on the serious side.

Best Treatments for Big Toe Pain

The treatment for first toe pain is dependent on the condition but there are lots of methods that overlap and relieve pain. It is best to see a podiatrist so they can create a treatment plan specific to your condition and symptoms. A form of imaging can be used to confirm a diagnosis. An x-ray, ultrasound or MRI can all provide accurate answers as to what is occurring within your big toe. Icing and non steroidal anti inflammatory medications can be very effective in reducing acute big toe pain and reduce swelling. Conditions such as hallux rigidus and rheumatoid arthritis may require other medication that can be recommended by a rheumatologist. Foot strapping can be an effective treatment option for turf toe. There are a variety of insole and orthotic modifications that can be implemented to take pressure off the first toe or to provide it with added support. The use of pillows stacked next to your foot in bed to prevent the doona and sheet from touching the big toe whilst in bed is an effective way to keep pressure off the toe whilst trying to get a good night’s sleep. Tight shoes can create shooting pain through the entire toe if it compresses on a nerve. Wearing shoes that fit correctly both help to protect and support your foot reducing the chance of toe injury.

When to see a podiatrist?

You should see your Bayside podiatrist the moment you begin to notice pain or any of the other symptoms, especially if it’s at night. If you think you have suffered from any of these conditions in the past it is also worth seeing a podiatrist as they can assess your foot and find possible causes. This will reduce your chances of suffering from any of these conditions in the future and keep you pain free.

Make an appointment by clicking on this link: https://www.footcentregroup.com.au/book-online/ or by calling our Moorabbin clinic at 03 9553 0044, Edithvale at 03 9772 9579 and Malvern East at 03 9021 2067.

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