Pain in the second toe is a common complaint among runners and active people. There are many possible causes of second toe pain, with different treatments, so an early diagnosis matters.
Anatomy of the second toe
The second toe is made of bones and joints. The 2nd metatarsal links your midfoot to the toe, and the toe itself has three phalanges — proximal, middle, and distal. Between the metatarsal and the proximal phalanx sits the metatarsophalangeal (MTP) joint, which has a thin capsule reinforced underneath by the plantar plate. Between the phalanges are the proximal and distal interphalangeal joints.
One predisposing factor worth noting: in some people, the second toe is longer than the big toe — a “Morton’s toe” or “Greek foot.” The longer second toe takes more load, which raises the risk of several of the conditions below, and often produces a thick callus under the second metatarsal head.
Causes of second toe pain
Second toe arthritis
Both osteoarthritis and rheumatoid arthritis can affect the second toe MTP joint. The base of the toe becomes painful and swollen, worse with walking and running. Persistent inflammation can lead to a hammertoe — a claw-like deformity from malalignment of the MTP joint. Treatment usually means the right footwear, insoles, and sometimes an injection.
Plantar plate injury
The plantar plate is a thickening of the capsulobase beneath the MTP joint that supports the joint. Plantar plate injuries are most common in the second toe, because it’s the longest. Pain sits at the top or bottom of the toe, worse with walking, running, and sports. On examination, moving the toe up and down is painful and shows excess movement. Ultrasound and MRI detect a tear.
Most cases are treated without surgery using taping, orthotics, and a stiff-soled shoe — avoiding barefoot walking for at least six weeks, with the tape changed every 2–3 days.
Freiberg’s disease
Freiberg’s disease is a rare cause of disease affecting the head of the metatarsal. It’s commonest in teenage girls but also occurs in adults. The blood supply to the metatarsal head is thought to be disrupted, though why isn’t clear (trauma, sport, or high heels may contribute). The bone becomes painful and swollen, then breaks down and flattens, eventually leading to arthritis. Early detection is key to preventing collapse. X-ray or MRI confirms it; treatment is rest from impact and orthotics to offload the toe, with a gradual return as the bone heals.
Second toe stress fracture
Like Freiberg’s disease, a stress fracture causes bone fatigue, swelling, and breakdown — but in the shaft rather than the head. Pain worsens gradually with impact, sometimes with bone swelling. MRI is the investigation of choice (X-ray and ultrasound can miss it). Treatment is rest from running, a walking boot, and a graded return over a few months, longer for fractures nearer the midfoot. We sometimes check bone health with a DEXA scan and blood tests (such as vitamin D and a bone profile).
Morton’s neuroma
Morton’s neuroma is a thickening of an interdigital nerve in the forefoot. It causes shooting or burning pain at the base of the foot, often spreading to the second and third toes — the relevant nerve supplies the second and third toes, so it’s a classic cause of pain between the second and third toes. Numbness or tingling may occur, worse with walking, running, or tight shoes. Ultrasound or MRI confirms the thickened nerve and excludes other causes. Treatment is a wider forefoot shoe, insoles, sometimes a cortisone injection, and occasionally surgery.
Sausage toe (dactylitis)
A “sausage toe” is a gross swelling that makes the toe look like a sausage. It occurs in up to 50% of cases of psoriatic arthritis and is often the first sign, before other symptoms. It causes swelling, redness, and pain that can last months. A sausage toe warrants blood tests and an ultrasound or MRI to confirm the diagnosis and exclude other causes — including gout, infection, and sarcoidosis.
Injections for second toe pain
Cortisone injections are reserved for certain conditions — second-toe arthritis and Morton’s neuroma — after simple treatments have failed. It’s worth knowing the benefits and side effects of cortisone first. Injecting under ultrasound guidance improves accuracy and effectiveness while reducing the risk of damaging nearby structures.
Frequently asked questions about second toe pain
Do Morton’s neuromas go away on their own?
Usually not — but symptoms can settle with simple measures such as a wider shoe and orthotics, so a neuroma doesn’t always need an injection or surgery for the pain to improve.
Why are my toes separating?
Sometimes the collateral ligaments on the side of the second toe tear, letting the toe drift sideways and widening the gap between toes. This often goes alongside a plantar plate tear.
Can I get gout in my second toe?
Yes. Gout is commonest in the big toe but can affect any part of the foot. Gout attacks come on suddenly with acute pain, swelling, and redness — early anti-inflammatory treatment is key.
What causes pain between the second and third toes on the top of the foot?
The classic cause is a Morton’s neuroma affecting the nerve to the second and third toes, which can cause burning pain and tingling that spreads between them. Other causes include MTP joint synovitis and, occasionally, a nerve entrapment higher in the foot, so imaging helps pin down the source.
What is sausage toe?
Gross swelling of the toe so it looks like a sausage, often a sign of inflammatory arthritis such as psoriatic arthritis. It warrants blood tests and imaging.
When should I see a doctor for second-toe pain?
If the pain is persistent, the toe is swollen or red, you suspect a stress fracture (worsening pain with impact), or there’s a sausage-like swelling. These point to causes that require specific treatment rather than changes to footwear.
Final word from Sport Doctor London about second toe pain
Second toe pain has many possible causes, so an accurate diagnosis is the key to the right treatment. If you’re considering an injection, see a medical doctor experienced in injecting under ultrasound.
To book a foot assessment with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
Related conditions:
Click on the Site of Your Foot Pain to Find Possible Causes
Plantar big toe pain
- Sesamoiditis
- Hallux rigidus
- Adventitial Bursitis Big Toe
- Flexor hallucis longus tendonitis
Sole of forefoot
Heel pain
Medial arch pain
- Plantar fibroma
- Atypical plantar fasciitis
- Plantar fascia tear
- Mid-foot arthritis
- Knot of Henry pain
- Jogger's Foot
Second toe pain
Mid-foot pain
- Mid-foot arthritis
- Lisfranc injury
- Navicular stress fracture
- Os naviculare
- Tibialis anterior tendonitis
- Knot of Henry pain
- Metatarsal stress fracture
- Kohler's disease
- Spring Ligament Tear
- Jogger's Foot
Heel pain
Front of ankle
Mid-foot pain
- Cuneiform stress fracture
- Base of second stress fracture
- Mid-foot arthritis
- Deep peroneal nerve entrapment
How long does it take to recover from friebergs disease? When can I go back to sport?
Hi Charlie, Thanks for your question. It can take o=months to recover from Freiberg’s disease. The key is to pick it up early. The earlier the diagnosis, the less time you need to rest. You can go back to sport once pain and swelling settle and you are able to tolerate a progressive walking and running program.
The index toe of my right foot is swelled up,is possible that I’m injured in my tendon?
Hi Chris, if you’re toe became swollen for no reason then the possibilities include MTP joint arthritis or a condition called dactylitis. Dactylitis – which is swelling of the tendons of the toe- could have an underlying reason such as inflammatory arthritis.
Lorenzo
I have had pain in my foot for several weeks. Not sure what I did , but there was some puffiness and bruising on top of the foot . The pain is in my second toe but also runs up the top of the foot to about half way up toward the ankle.. it worsens with increased walking to the point where I’m limping. If I push the toe downwards , the toe hurts , especially in the joint at the base of the toe.
Is it likely to be a fracture or just tendinitis ?
Hi Caroline, If you’ve increased your activity, walking, or running, then it could be a stress fracture. I’d see a doctor.
Right under my second toe if i squeeze it it hurts sometimes when i walk it hurts i cant seem to figure out whats wrong with it. It doesn’t hurt all the time which is weird.
How did you get to treat yours please
I have quite a bit of pain in second toe , pain when touched – and if I put weight directly on it – but not if flexed or extended. Any ideas?
hi Sue, it could still be the joint of the 2nd toe – as outlined in the blog. Either degeneration or a plantar plate injury.
Lorenzo
I have a spot on my second toe that is directly under toenail and is very hard. Almost like another nail growing. It’s been there for several months and hurts every time I barely bump it. What can it possibly be ?
It might be a callous that has grown secondary to friction. i’d see a doctor about any spot that doesn’t settle within a few weeks. LM
every few weeks i’d say i get a small swelling , with no/small amount of redness on my second toe on my right foot i’m not too sure what it could be it only hurts when putting shoes on walking for long times and if i press on it when i leave it it feels like it burning ( like when you put anti-septic cream on a bite) it could be the shoes i wear routinely as i didn’t get it over the break when i didn’t wear these shoes but i think it’s very unlikely as it has only started to become an issue recently.
I stubbed the tip of my second toe so hard the nail split and I continue to have a dark purple bruise. It is very painful still, even though the injury was two weeks ago. How long will this take to heal?
Hi, It should settle in the next few weeks. If not, then you should see a doctor. Lorenzo
The top joint in my second tie just started hurting the other night and had progressively gotten worse especially when I walk the pain shoots up the top of my foot making it painful to walk! What can I do for the pain before I get into the dr because that might take a month?
hi,
I’d suggest ice packs every 4-6 hours and topical and oral anti-inflammatories. if it doesn’t settle within a week, then you should see your doctor.
https://sportdoctorlondon.com/how-long-does-it-take-for-ibuprofen-to-work/
Lorenzo
Hi, my second toe on my right foot and my 3rd toe on my left foot both are very painful, swollen, red and cold to the touch. Hurts when I walk what could this be.
Hi Lisa, it could be inflammation of the joints of the toes (MTP joints). You need to see a doctor if it doesn’t settle.
Lorenzo
The top joint of my second toe of the right foot started hurting. It is only in one small area on the side of the big toe. The pain appears in the morning when I wake up and in about 5 minutes after I start walking goes away. It came and went away every couple of days for the past 3 weeks but this morning was really intense and it took 50 minutes to go away. It was a sharp pain like a piece of glass was stuck there or like a paper cut. The toe is not red and there is no swelling. The pain was not affected by local ibuprofen. What can it be? Thank you for your help!
Hi Alina,
You may have inflamed the last joint of your second toe, also known as the DIP joint. If it’s not red, then it’s unlikely to be joint wwswelling. I suggest your doctor should see it if it doesn’t get better soon. Lorenzo
Hi Lorenzo, I came across this page while looking for info on Morton’s Toe (as in Greek toe, rather than Morton’s neuroma), and was surprised not to see it mentioned. Perhaps you might consider adding it in? The distinctive callous pattern includes a thick callous under the head of the second metatarsal. Thanks for writing the page, good reading.
thank you. Yes, I think I may. Lorenzo
I have pain under both second toe plantar MPT joint for a year. This started about 5 months after a surgeon unnecessary did a pernicious tenotomy on both second toes. I also have a crushed seisimoid on right foot . What would be the right type of orthotics to get as I have not much success. The metatarsal padded one irritate foot . The cut outs for second toe put pressure on seisimoid. Should I triage ?? Thank you
Hi Joanne, oh sounds complicated as offloading sesamoid will upset the second toe and vice versa. I’d suggest seeing an expert podiatrist with an interest in biomechanics and orthotics. Lorenzo
Hi, I have had 6 months of pain on the plantar surface, over the second MTP and proximal phalanx. Progressive Swelling of proximal phalanx. Getting progressively worse despite orthotics, nsaids, ice, steroid injection. I had an MRI today showing pulley system injury with detached flexor tendon and flexor tenosynovitis. Wondering what treatment options are available. The radiologist told me it’s like acute trigger finger of the second toe, and he has never seen this in a toe before.
hi Bradley, I wonder whether you have a condition called dactylitis. This is also called sausage toe. It is often the first sign of inflammatory arthritis such as psoriatic arthritis.
You should speak to your doctor about tests to rule out inflammatory arthritis.
Lorenzo
Hi Lorenzo,
My symptoms match Bradley Kutha’s question as i have had pain for last 4mnths left foot 2nd toe. X-ray ruled out fracture & now awaiting specialist appn. Pain at times radiates to knee & hip. It may be a form of arthritis but its constant.
My second toes ( right beside the big toe) on both feet are both very sore. It looks like I’m going to lose the nail on both of them. With golf opening I have been doing a lot of walking. Any ideas?
I’d see a podiatrist to review your footwear and consider padding/orthotics. Lorenzo
Hi Lorenzo
I just had a cortisone injection 4 days ago in my right foot (sort of neuroma) and I was wandering if I would be able to have an oral treatment with anti inflammatories to get rid of the inflammation for good.
I cant find any infos about having had a cortisone injection and taking an anti inflammatory treatment for few days.
would you know a bit more on this Please. Thank you for your answer
yes anti-inflammatory tablets would be reasonable – please read this blog on these medications:
https://sportdoctorlondon.com/how-long-does-it-take-for-ibuprofen-to-work/
Hi Lorenzo,
I literally am struggling to walk as my feet seem to have thickened up and frozen.
I’m now hobbling! Both feet struggle to bend when I get up to walk.
The pain is extreme throughout the front of my feet especially and in my toes.
I have bunions developed on both feet now and bunionettes. My toes feel broken. So difficult to bend.
I try to stretch them out apart from each other without touching my feet which is agonising but I feel is the only thing I can do
to stretch and get some relief. I did go to a trained ppdiatrist a year ago who gave me exercises but it is just so much worse now.
My feet are now much wider and absolutely kill me when I put my running shoes on in spite of
the laces being loosened to the last mm in wide fitting shoes.
I don’t know what to do. I think I am developing some form of arthritis.
My Mum died of osteoporosis in her 60’s and I am approaching that age, imminently.
I am very active and used to walk, 5km a day. Now, I can’t go outside with the pain and discomfort.
Please can you advise treatment or what to do next? I don’t want to fuss.
Thanks so much
Hi, I recommend you see a doctor. Stiffness swelling and pain over a long period are suggestive of inflammatory arthritis.https://sportdoctorlondon.com/inflammatory-arthritis-what-to-look-for/
Hi, I sprained my ankle a year ago and somehow it affected my index toe. My index toe is stiff. Whenever i tried to bend my index toe, my whole feet will be swollen. What’s wrong?
You may have injured the joints of your 2nd toe – MTP or TMT joints. I’d speak to your doctor if it doesn’t settle.
Hi. I had cheilectomy and Weil osteotomy done in October and am still recovering. I originally got the procedure done due to feeling an excessive amount of pressure being put on my second mtp joint when standing. As of now I still have that same feeling in my second joint only worsened now. And on top of that, the entire ball of my foot is now inflamed to the point of my toes not laying flat on the floor when I stand. I’ve had multiple injections and gone thru PT. Apart from doing daily stretches and icing I’m not sure what else I can do. The doctor tells me it’s not common to have so much inflammation in the ball of my foot still at this point, but it could also be a mixture of internal scar tissue as well. Any thoughts?
I’m assuming someone has excluded a dactylitis: https://sportdoctorlondon.com/inflammatory-arthritis-what-to-look-for/
An ultrasound scan can clarify the cause.
If so, then offloading the toe with orthotics might be helpful.
Hi I am suffering from pain in the ball of my left foot ,which is making it very
difficult to walk,my 2cnd and 3rd toe are swollen at the base,where the joints meet my foot,if I walk or am on my feet
too long I developed bruising on mapper foot ate base of these toes .can you please advise
Hi Lesley, I think you might have a problem with the MTP joints (I mention this in my blog). The other possibility is that you have Morton’s neuroma. Please see my blog and links to my blog for further information. I suggest you see your doctor for further assessment and investigation. LM
overall very helpful and free of course, and so I am grateful, but your written explanations accompanying your diagrams could be improved upon.
e.g. – this bit :-
“The second toe consists of bones and joints. The 2nd metatarsal bone links your ankle with your second toe. The toe consists of three bones called the proximal middle and distal phalanx. Between the metatarsal bone and the proximal phalanx is the metatarsophalangeal (MTP) joint. These joints have a thin joint capsule reinforced below by the plantar plate.”
You state that the (second) toe consists of 3 bones and then list only two before ending that sentence..
Thanks Chris, for the feedback. I’ve amended the introduction.
LM
I have very bad pain in my second toe – in the second joint from top. I also have a severe bunion. The pain is constant. The deformity is the big toe pushing towards the second toe and the second toe is going above the big toe. Is this a known condition? I am a rock climber who wears tight shoes and the pain is unbearable.
you probably have a hallux valgus deformity. If painful, you should see a surgeon about correction.
LM
Hi, A few months ago I started having an intermittent sudden burning pain along the left side of my right second toe. The tip of the toe from the base of the nail to the top is red and swollen. The swelling is quite firm but tender and painful as well. I would welcome some suggestions. Thank you
hi Hard to advise without seeing your toe. Burning pain that doesn’t settle always needs investigation to exclude certain conditions ie Morton’s neuroma https://sportdoctorlondon.com/mortons-neuroma-injection/
other possibility is dactylitis from inflamamtory arthropathy
https://sportdoctorlondon.com/inflammatory-arthritis-what-to-look-for/
Hi
I dont know if this comment section is still active, but I just fount it.
I have had pain under and above my second toe. It hurts when you press og flex it. MRI and X-ray shows nothing. It’s not swollen or red. The orthopaedic doctor looked with ultrasound, but sees nothing. He doesn’t t know how to further help me. I suspect some damage from a tough march last summer in steep conditions and the doctors only guess is a beginning stress fracture, but nothing can be seen in pictures. It doesn’t feel, like I walk on a marble or anything, ist a throbbing and sometimes sharp pain. Also when I lie down or sit still. Not all the time, but everyday.
If imaging doesn’t show any abnormality, I’d suggest you see a podiatrist to discuss ways to offload the toe using appropriate footwear, taping or orthotics. You may be experiencing pain from biomechanical overload of the toe, so using orthotics to offload the toe may improve your pain.
LM
I have severe hallux valgus on right foot. The big toe leans against second toe, which is a sausage toe, and after a while second toe hurts and gets burning sensation. The only way the pain stops is when I place second toe over the big toe. Lately I have noticed that big toe is getting red and puffy and it hurts. Podiatrist gave me a shot because of arthritis on second toe, but it did not stop the pain.
Do you think I should have surgery to eliminate hallux valgus, even though I am 80 years old?
Yes surgery is an option if you have increasing pain. I’d speak you your doctor.