Pain in the second toe is a common complaint in runners and active sportspeople. There are many possible causes of second toe pain with different treatment options. So, getting an early diagnosis of second toe pain is essential.
Anatomy of the second toe
The second toe consists of bones and joints. The 2nd metatarsal bone links your ankle with your second toe. The toe consists of the proximal, middle and distal phalanx bones. Between the metatarsal bone and the proximal phalanx is the metatarsophalangeal (MTP) joint. This joint has a thin joint capsule reinforced below by the plantar plate. Moreover, two interphalangeal joints between phalanxes exist – the proximal and distal interphalangeal joints.
Causes of second toe pain
There are many causes of 2nd toe pain. Some of these conditions include:
Second toe arthritis
Both osteoarthritis and rheumatoid arthritis can affect the second toe MTP joint. Generally, the base of the toe is painful and swollen, mainly when walking and running. In addition, persistent inflammation of the second toe can lead to a hammertoe deformity – a malalignment of the MTP joint causing the toe to become claw-like.
Treatment generally consists of the correct footwear, orthotics, and an injection.
Plantar plate injury causing second toe pain
The plantar plate is a thickening of the capsule under the MTP joint. Generally, it helps to support the joint. Injuries to the plantar plate are more common in the second toe as this toe is longer than the others. Usually, pain presents at the top or bottom of the toe and is worse with walking, running, and sports.
When examining someone with a plantar plate injury, there is pain with pushing the toe into flexion and extension. Also, moving the toe upwards and downwards shows more significant movement than usual.
Generally, ultrasound and MRI can detect a plantar plate tear.
Most cases can be treated without surgery consisting of taping, orthotics, and a stiff-soled shoe. Generally, we don’t allow barefoot walking for at least six weeks. After that, taping should be changed every 2-3 days.
Freiberg’s disease: an uncommon cause of second toe pain
This is a rare condition affecting the head of the metatarsal bone. While more common in teenage girls, Freiberg’s disease can also occur in adults.
Generally, we think the blood flow in the metatarsal head is disrupted. However, we don’t know why: trauma, excessive sport, or wearing high heels could be factors.
Initially, the end of the metatarsal bone becomes painful and swollen. Then, the bone begins to break down, collapsing into small pieces. Finally, the head of the bone becomes flattened, leading to arthritis. Importantly, detecting this condition early is the key to preventing bone collapse.
Often, imaging such as X-ray or MRI can diagnose the condition. Overall, treatment consists of rest from impact activity such as running and orthotics to reduce the load on the second toe and spread forces to the other toes. Then, as the bone heals, you can slowly resume impact activity.
Second toe stress fracture
Like Frieberg’s disease, a stress fracture leads to bone fatigue, swelling, and breakdown. However, the stress fracture site is usually in the shaft rather than the head.
Generally, symptoms consist of gradually worsening pain with impact activity. In addition, there may be swelling in the bone.
Overall, MRI is the investigation of choice. X-ray or ultrasound may also detect stress fracture changes, although they may miss some cases.
Treatment consists of rest from running in a walking boot followed by a graded return to running slowly over a few months. However, recovery can take much longer for stress fractures higher up in the foot (near the mid-foot).
Morton’s neuroma
Morton’s neuroma is a thickening of a nerve in the front of the foot between the toes (interdigital nerve).
Generally, symptoms of Morton’s neuroma include shooting or burning pain at the base of the foot. Pian usually spreads to the two toes (so the second nerve spreads to the second and third toes). Also, numbness or pins and needles may occur. Usually, symptoms are worse with walking, running, or wearing tight-fitting shoes.
Diagnosis is based on the clinical findings and imaging showing thickening of the nerve between the two toes. Generally, ultrasound or MRI are used to confirm nerve thickening and to rule out other causes such as joint arthritis or plantar plate injury.
Overall, treatment consists of wearing shoes with a broader forefoot to give your foot room to move. Shoe inserts may also help distribute weight away from the Morton’s neuroma. Sometimes, a cortisone injection into a Morton’s neuroma can help. Finally, surgical removal may be needed.
Sausage toe or Dactylitis
Sausage toe refers to gross toe swelling, making the toe look like a sausage. It is common in up to 50% of cases of psoriatic arthritis. Often, it is the first sign of disease before other symptoms occur.
Symptoms of sausage toe include swelling, inflammation, redness, and pain. Often, symptoms can be present for many months.
If you have a sausage toe, we recommend blood tests and ultrasound or MRI to confirm the diagnosis and rule out other causes. Other causes of a swollen toe include gout, infection, and sarcoidosis.
More on injections for second toe pain
Generally, cortisone injections are only used for certain conditions after failed simple treatment. These conditions include second-toe arthritis and Morton’s neuroma.
You should be aware of cortisone injection’s potential benefits and side effects. Also, injecting under ultrasound improves accuracy and effectiveness and reduces the chances of damage to other structures.
Commonly asked questions about second toe pain:
Do neuromas go away on their own?
Generally no. However, some cases can improve with simple treatments such as a change in footwear and orthotics. So, a neuroma doesn’t necessarily need to be injected or removed for the pain to settle.
Why are my toes separating?
Sometimes, the ligaments connecting the side of the second toe (also called the collateral ligament) tear. This forces the toe to move to the other side, increasing the distance between the toes. Often, a tear of the collateral ligaments is associated with a plantar plate tear.
Can I get gout in my second toe?
Yes. Although gout is more common in the big toe, you can also suffer gout in other parts of the foot. Usually, gout attacks come on suddenly with acute pain, swelling, and redness of the toe. But, again, early treatment with anti-inflammatory medications is the key.
What is sausage toe?
Sausage toe refers to gross swelling of the second toe so that the toe looks like a sausage. Often, it is a sign of inflammatory arthritis, such as psoriatic arthritis.
Final word from Sportdoctorlondon about second toe pain
Given the many causes of second toe pain, seeing a doctor with expertise in diagnosing is essential so the correct treatment can be started immediately. Also, if you are considering an injection, you should see a medical doctor with expertise in injecting under ultrasound.
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/