Have you noticed a dull ache or sharp twinge in the toe next to your big toe? It could be from walking around barefoot at home or from a long day in heels. You might even feel it after a weekend hike, long run or just standing on hard floors all day.
Second toe pain is surprisingly common and it can affect people of all ages and activity levels. Some days it might be a minor annoyance, while other days it can make every step uncomfortable.
“Second toe pain often comes from pressure, an acute injury, repetitive stress (or overuse) or the way your foot is built,” said Daniel Arrhenius, DPM, a podiatrist and foot and ankle surgeon with Banner Health. “Genetics, footwear and lifestyle habits also play a role.”
The good news, according to Dr. Arrhenius, is that most causes of second toe pain are treatable. He shared the common causes for second toe pain, symptoms to watch for and when to see a podiatrist or foot and ankle specialist.
Common causes of second toe pain
Several conditions and injuries can cause pain in your second toe. Here’s a closer look at the most common ones:
Capsulitis
Capsulitis happens when the joint capsule (the connective tissue around the base of the toe joint) becomes inflamed. This often occurs in the second toe, where pressure on the ball of the foot can irritate the joint.
“Capsulitis is a progressive condition,” Dr. Arrhenius said. “In early stages, you may notice pain or swelling around the base of the second toe, especially when walking barefoot or performing activities that put pressure on the forefoot.”
Morton’s neuroma
A Morton’s neuroma is a thickening of the tissue around a nerve in the ball of your foot, usually between the third and fourth toes.
“Neuromas can cause numbness, tingling or sharp burning pain,” Dr. Arrhenius said. “People often describe it as feeling like they’re stepping on a pebble or a marble.”
Hammertoe, claw toe or mallet toe
These involve abnormal bending in one of the toe joints, usually the middle joint for hammertoe.
“Toe deformities like hammertoes, claw toes or mallet toes can create friction and pain, particularly if shoes push the toes into an unnatural position,” Dr. Arrhenius said.
Pressure from a bunion
A bunion is a bony bump that develops at the base of the big toe, on the joint where the toe meets the foot (the first metatarsophalangeal joint). As the big toe shifts toward the smaller toes, it can crowd the second toe and cause it to go out of alignment.
“When the big toe moves toward the other toes, it increases stress on the second toe joint,” Dr. Arrhenius said. “This can lead to inflammation and discomfort.”
Plantar plate injury
The plantar plate is a thick ligament under the toe that stabilizes the joint and prevents overextension. Injury or tearing of this ligament, often from repetitive stress or certain foot shapes, can cause pain at the base of the second toe.
“Like the symptoms of Morton’s neuroma, some people may feel like they are walking on a marble, with swelling or toe displacement,” Dr. Arrhenius said.
Other causes
Other possible reasons you might have second toe pain include:
- Arthritis
- Fractures
- Sprains
- Overuse injury
- Improper or ill-fitting shoes
Symptoms to watch for
The type of pain you feel can help identify the cause. Watch for:
- Pain in the ball of the foot
- Pain near the base of the second toe
- Aching, throbbing or sharp stabbing sensations
- Feeling like you’re walking on a pebble or marble
- Stiffness, redness or swelling in the toe joint
- Numbness, tingling or burning (especially with neuroma-related pain)
- Pain that worsens with certain shoes, activity or after standing
- Visible changes in toe alignment, like curling or drifting sideways
“If pain is due to tight shoes, change to shoes with a wider toe box,” Dr. Arrhenius said. “But if the pain continues despite rest, padding, icing or anti-inflammatories, it could be a more serious injury or underlying problem that should be checked out.”
[Also read “DIY Foot Care or Professional Help? When to See a Podiatrist.”]
When to see a podiatrist
Many mild cases improve with rest and supportive shoes. But you should see a podiatrist or foot and ankle specialist if:
- Pain lasts more than a few days or keeps getting worse
- Walking or putting weight on the foot is difficult
- You notice visible changes in toe shape or movement
- Rest, icing or changing shoes doesn’t help
- You feel numbness, tingling or burning
“Early evaluation is important,” Dr. Arrhenius said. “It helps us figure out if the pain is from a nerve, like a Morton’s neuroma, or a joint or ligament problem, like capsulitis or a plantar plate injury. Proper treatment depends on knowing the cause.”
How second toe pain is treated
Treatment depends on the cause, but many approaches are non-surgical and effective. Options include:
- Rest and activity changes: Reduce high-impact activity or temporarily avoid sports that stress the toe.
- Anti-inflammatory medications: Over-the-counter (OTC) NSAIDs, such as ibuprofen, can provide relief.
- Proper footwear: Shoes with a wide toe box, supportive sole and low heels reduce pressure.
- Ice or cold packs: Help lower inflammation and ease discomfort.
- Orthotics or metatarsal pads: These devices redistribute weight to relieve pressure on the ball of the foot.
- Taping, splints, or strapping: These stabilize the toe while ligaments or tendons heal.
- Physical therapy: PT strengthens foot muscles, improves balance and reduces the recurrence of foot problems.
Dr. Arrhenius added, “Surgical correction is usually only considered when conservative treatments haven’t worked or when deformities like hammertoe or bunions contribute to the problem.”
How to prevent second toe pain
You can reduce your risk of future pain by:
- Wearing shoes with a wide, deep toe box and a stable sole to reduce pressure on the toe bones and joints
- Limiting long-term use of high heels
- Avoiding repetitive pressure on the forefoot
- Stretching and strengthening foot muscles regularly
- Resting at the first sign of discomfort
- Maintaining a healthy weight to reduce pressure on the toes
“Paying attention early and adjusting footwear or activity can prevent minor pain from becoming chronic,” Dr. Arrhenius said.
Takeaway
If your second toe pain continues, it’s time to get a professional to identify the cause. Banner Health foot and ankle specialists can help identify the cause, whether it’s capsulitis, a neuroma, plantar plate injury or another issue. We offer advanced imaging, custom treatment plans and support to help you move comfortably again.
Schedule an appointment with Banner Health today.
