Turf Toe

Turf toe is a sprained joint in the big toe due to excessive upward bending. It is usually a sports injury that occurs as a result of jamming the toe suddenly or pushing off repetitively while running or jumping. Athletes who play sports on turf surfaces, such as football and soccer, are prone to turf toe, which is what gave the condition its name. However, gymnasts, basketball players, dancers, and wrestlers can also suffer from turf toe due to the movements involved in their sports.

Turf toe causes pain, swelling, and restricted movement, as does any other sprain. The sprain can happen over time with gradually worsening symptoms or suddenly with acute pain and an immediate onset of symptoms. X-rays can be taken to rule out bone injury and fractures. Treatments include rest, ice, and elevation. Compression and anti-inflammatory medications may also help (check with a doctor before taking any medication).

Subungal Exotosis

Subungal exotosis is a bony projection, or bone spur, that forms underneath the big toenail. It usually occurs on the big toe as a result of injury or trauma such as crushing the toe. Subungal extoses are painful because the affected area on the outside of the big toe is subjected to pressure from walking and footwear. Surgical removal of the projection is usually recommended and necessary. Enchondromas also develop in the bone underneath the toenail; these are small, benign growths composed of cartilage.

In-Toeing and Out-Toeing

In-toeing is when the feet turn inward instead of pointing straight ahead when walking or running. Out-toeing is when the feet point outward instead of straight ahead when walking or running. The conditions are generally painless. Concerns from mispositioning of the feet when walking are an unsteady gait that can lead to tripping, stumbling, and falling

Although many children have in-toeing or out-toeing, most cases resolve themselves by two years old without any intervention at all beyond a simple reminder to the child to properly position the feet. In cases that do not rectify themselves over time, foot supports or special shoes can alleviate abnormal pressures on the foot caused by the mispositioning, preserving foot structure from damage and limited function later on.

General Toe Deformities

Toe deformities such as hammertoes, claw toes, mallet toes, and overlapping and underlapping toes can be congenital, inherited, or develop over time as a result of an injury, recurring pressure, or degenerative disease. Deformities to toe joints can cause pain and impaired function.

Individuals with foot and toe structure abnormalities, such as long toes and arch problems are more prone to subsequent toe deformities because the foot is imbalanced. Injuries that do not heal properly and ill-fitting footwear can also lead to toe deformities.

Overlapping and Underlapping Toes

Overlapping and underlapping toes occur when toes are out of position. The conditions can be congenital due to inheritance or the fetus’s in-utero position, or they can develop over time from ill-fitting footwear that constricts or pressures the toes, keeping them bunched rather than flat. It can also stem from a bunion.

An overlapping toe lies across the top of an adjacent toe rather than staying in its straight position. This is most common with the fifth toe. An underlapping toe lies behind another toe; this most commonly affects the fourth and fifth toes. Congenital curly toe is a condition where the toes curl and point to the outside of the foot. It is usually congenital and can be worsened by ill-fitting footwear. As a result of toe overlapping or underlapping, blisters, irritation, corns, and calluses may form as the toes rub against one another and footwear.

Treatment for overlapping and underlapping toes involves stretching and taping the toes, which is usually how the condition is treated in infants. However, the mispositioning usually returns. Surgery to release the tendons and soft tissues at the toe joint at the base of the toe may be necessary, and in severe cases, a pin can be temporarily inserted in the toe to correct its position. With underlapping toes that are inflexible and fixed in position, surgery can remove bone in the toe to improve flexibility.

Hammertoe

Hammertoe occurs when the second, third, or fourth toe bends at the middle joint, often as a result of wearing ill-fitting shoes. Genetics, arthritis, and muscle imbalance can also cause hammertoe. The affected toe resembles a hammer, which is where the deformity it gets its name. With hammertoe, the toe bends downward, rather than pointing straight forward. Corns or calluses frequently develop at the top of the affected joint or at the toe’s tip from pressure. Hammertoe can cause pain and can lead to loss of flexibility in the toe.

To treat hammertoe, wear comfortable shoes with large toe boxes, as it commonly develops from shoes that are too small, narrow, or high-heeled. It can also result from injury, arthritis, or a high foot arch. Shoe inserts can help when a high arch is the cause. Over-the-counter treatments are available to alleviate the related corns and calluses. Toe stretches can help restore the toe’s correct position, as well as lessen the pain.

Hallux Varus

Hallux varus is a deformity of the big toe joint that results in the big toe pointing outward, or away from the other toes, whereas a bunion would cause the big toe to lean inward. Hallux varus can be congenital, or it can occur from overcorrective bunion surgery, a tight or short abductor hallucis tendon, or injury.

Aside from the direction of the toe pointing outward, symptoms of hallux varus are pain, redness, and blisters on the toe from it rubbing against footwear. An ingrown nail on the big toe may also develop from pressure. The condition can be treated by stretching and splinting the abductor hallucis tendon. For more severe cases, surgery can straighten the toe.

Hallux Rigidus

Hallux rigidus is a degenerative arthritis affecting the joint of the big toe that eventually causes the toe to become rigid, or unmovable. Over time, the toe’s motion decreases due to wear-and-tear that deteriorates the articular cartilage, making it difficult to walk, run, or climb stairs, all of which involve pushing off of the big toe. In time, standing or putting weight on the affected area can become painful. Hallux rigidus starts with hallux limitus, which involves stiffness and a limited range of motion of the big toe joint.

As a result of hallux rigidus, bunions, calluses, and bone spurs can develop on top of the bone. There is also pain and swelling around the affected joint. Treatment for hallux rigidus involves the use of ice, rest, over-the-counter anti-inflammatory medications (ask your doctor first), and cortisone injections at the site. Stiff-soled or rocker-bottom footwear and orthotic inserts may alleviate pressure to the area, and shoes with a larger toe box area may also help. Surgery can become necessary in advanced or painful cases.

Hallux Limitus

Hallux limitus, an arthritic condition of the hallux, or big toe, involves stiffness in the joint at the base of the big toe. Abnormal alignment of the first metatarsal bone is usually the cause of the condition that restricts motion. Injury, overuse, and genetics are other reasons for the development of hallux limitus.

Symptoms include sudden sharp pain, or the gradual development of discomfort and pain over time, as well as swelling and inflammation that are aggravated by pressure from footwear. Hallux limitus can lead to wider spread joint problems, such as hallux rigidus, as well as calluses, bone spurs on top of the joint, and diabetic foot ulcers, if left untreated. Hallux limitus can be treated with orthotic inserts to stabilize and support the area, ice, rest, over-the-counter anti-inflammatory medications (ask your doctor first), and cortisone injections at the site.

Enchondroma

Enchondromas develop in the bone underneath the toenail and are small, benign growths composed of cartilage. The tumors are composed of cartilage that forms in the bone and are usually painless, which is why they often go undiagnosed unless they are revealed during X-rays or screenings done for other diagnoses. Enchondromas that form at the end of the toe feel similar to the pain of an ingrown toenail.

Enchondromas are the most commonly occurring bone tumors of the hands and feet. Enchondromatosis, or Ollier’s Disease, involves the growth of multiple enchondromas in the phalanges and metatarsals, or the small and long bones in the hands and feet. In the case of Maffucci’s Syndrome, enchondromas form benign soft tissue tumors, or hemangiomas, anywhere in the body. Hemangiomas involve the blood vessels and are more prone to becoming malignant than the enchondromas of Ollier’s Disease.

Enchondromas can be present in large areas of the bones, which thins the bone’s cortex, making it susceptible to breaks. Enchondromas usually require no treatment; however, if they grow enough to destroy bone tissue, they can be treated or surgically removed.