In this article, I’m going to talk about why people have numbness or pain in their big toe (and sometimes the 2nd and 3rd toes). Big toe pain is a common finding both in patients who have a history of low back pain and/or previous low back surgery.
I also treat a lot of patients that have big toe numbness who haven’t had a failed low back surgery and don’t have low back pain at all. It’s hard to understand how you could have a form of pain in your big toe and not have any low back problems but the low back could be related and should always be ruled out.
I know that if you have never suffered from low back, hip, or leg pain, that I may have just lost you. Read on. You’ll see that there is a method to the madness.
Often, patients will come in and explain how they have been to a podiatrist because they have foot pain or numbness/pain in their big toe. That is an understandable course of action because the big toe itself can develop pain from conditions such as gout, bunions, hammer toe, etc…
Additionally, diabetics and people who have rheumatoid arthritis can develop deformities of the toes which can be very painful. That is just one of many reasons to do everything in one’s power to keep conditions such as diabetes and rheumatoid arthritis in check. A small problem today can become a huge problem tomorrow.
However, this article is not about the explainable causes of big toe pain but what until now is largely misunderstood and unrecognized cause of big toe nerve pain.
Foot pain and numbness can be caused by a problem in the feet but it can also be a sign of a greater health problem and concern of impending permanent nerve damage.
Anatomy of the Big Toe
The big toe is an unusual in that it only has 2 phalanx joints. Most people don’t think about it but the big toe doesn’t have 3 phalanx joints like your other toes. The big toe is important for helping you keep your balance when you are standing or walking.
The actual medical term for the big toe is called the hallux. The hallux “big toe” only has 2 joints which makes the big toe different than your other toes from an anatomical standpoint. Click the link to read an interesting article on wikipedia to see pictures and learn more about the anatomy of the big toe.
Even though the big toe is different than your other toes, this difference isn’t usually the cause of pain and numbness. I’m going to discuss the neurology of the big toe later in this article, so stay tuned.
Why is Numbness Bad?
In working with severe low back and leg/foot pain patients for 15 years now, I have helped a lot of patients who weren’t able to get help from their nerve pain before they came to me. Numbness is a sign of possible nerve damage and should be taken seriously.
Even though some people would not consider numbness to be a form of pain, numbness is recognized as a descriptive term for a type of pain that someone may be experiencing.
Pain is what brings patients to me. People travel great distances and stay in hotel rooms, R.V.’s, campers, etc… to go through my unique treatment protocols for severe neck pain, chronic low back and leg/foot pain and peripheral neuropathy.
While pain is the motivator for many of my patients, I take function more seriously than pain. What I mean by this is that people often will take action when they are having severe pain but don’t realize that numbness can be a precursor to possible permanent nerve damage.
Can Numbness Become Permanent?
When you lose function because of permanent nerve damage, you usually don’t get it back. That’s because permanent nerve damage has the word permanent in the phrase.
As patients go through treatment, they tell me how they will go through phases as their nerves begin to get healthier and start to improve in function. Often, people will start with numbness, tingling, burning, weakness, etc… and transition into other sensations which can be a sign of nerve healing.
So, what does numbness in the big toe have to do with possible permanent nerve damage? The big toe needs what other joints need to be healthy and function properly.
Can Poor Circulation Cause Toe Pain?
The hallux needs a good blood supply and proper nerve function in order to work properly. Without a good blood supply, the tissues in the toe can die and function of the big toe can be lost.
That is the reason I include the Ankle Brachial Index Test as part of my new patient workup on every patient. The Ankle Brachial Index Test helps asses for a condition called Peripheral Artery Disease (PAD) in the lower extremities.
The PAD compares the blood pressure of the lower extremities with the blood pressure in the arms by using a formula to calculate if there is decreased circulation in the lower legs and feet.
Occasionally, a Toe-Brachial Index Test may need to be performed if there is severe circulatory decline due to stenosis or damage to the blood vessels in the lower legs and feet. PAD is commonly seen in diabetics.
The reason I do the ABI test is because I want to rule out (or rule in) circulatory issues that can be causing lower extremity numbness in my patients. While some will have some decreased circulation, without a blockage or anatomical defect, most people will have an ankle brachial index of greater than 1 which is normal.
Many patients tell me that their Dr. looked at their feet or toes and said that they have poor circulation. I’m saying that a visual check isn’t good enough. If you suspect poor circulation in your feet, get an ABI test.
How can Dermatomes be Related to Toe Pain?
When it comes to numbness in the big toe, a better understanding can come if one looks at a dermatome chart. Click the link to look at a dermatome chart of the lower leg and foot.
Dermatomes are formed during embryological development. This means that everyone will have slight variations because we all form a little different. A dermatome is the area of skin that will feel sensations from a specific spinal nerve that comes out of the spine.
What is the difference between Motor and Sensory Nerve Pathways?
I know it can be a little confusing because I just said that a spinal nerve comes out of the spine but that a dermatome is an area of skin that sends signals to a specific nerve in the spine. It should be a lot easier to understand after you read the next couple of paragraphs.
There are two nerve pathways in a spinal nerve. The motor pathway and the sensory pathway. Spinal nerves are literally like a highway with signals travelling through carrying electrical impulses to and from the brain.
The motor pathway sends signals from the brain to the muscles and organs to tell them what to do. The motor pathway goes from the brain out to the body and is the mover and shaker when it comes to performing actions.
The sensory pathway sends signals from parts of the body (such as the big toe) back to the brain. The sensory pathway is what tells you that you are in pain. It is what tells you when you get burned or step on a nail.
Now, things should be really clear. Even though a spinal nerve comes from the spine, it is a two way street. Signals come and go through the spinal nerve in both directions through motor and sensory pathways.
What Nerve goes to the Big Toe?
I know you may be thinking, “How is the big toe related to a dermatome?” The big toe and sometimes the 2nd that 3rd toes are part of the L5 dermatome. The L5 dermatome comes from the L5 nerve root that comes out of the spine in the low back.
Some patients will come to me and explain that they have no low back pain at all but their big toe is killing them. Others will have horrific low back pain and or hip pain and sciatic but didn’t realize that their low back and leg pain could be related to the same thing that is causing their pain or numbness in their big toe.
Can a Lightning Bolt Pain in the Big Toe be caused by a Pinched Nerve?
While this article is about numbness in the big toe, I’ve also had patients describe their big toe pain as feeling like a lightning bolt was about to shoot out of their big toe. Others will say it feels like a stick of dynamite is about to explode.
Once again, we are all different to a certain degree and pain will be perceived differently by different people. However, the most common link with neurological related big toe “pain” or numbness is the spinal nerve L5 from the low back.
If you have a degenerative disc (degenerative disc disease), a herniated disc, a bulging disc, muscle weakness, muscle atrophy, spinal stenosis, facet joint hypertrophy, a “slipped disc”, sciatica, low back or hip pain, cramping in your legs, restless leg syndrome, poor balance, failed back surgery, failed hip surgery, and other unexplained conditions, all of your symptoms could be coming from pressure on your L5 spinal nerve in your low back even if you don’t have low back pain.
How do Nerves Work?
All nerves understand is pressure. If there is enough pressure on your L5 spinal nerve (-70 mV resting membrane potential) it is enough to cause a nerve action potential and the nerve will fire in an all or none response.
If the L5 nerve root has pressure on it, any area of skin that the nerve root goes to can have abnormal sensation. Some people will have numbness while others will have burning, tingling or just straight up PAIN. However, the same problem of L5 nerve root impingement is usually the cause.
Can Big Toe Numbness be Helped?
Admittedly, surgery is sometimes the answer. However, surgery has risks and should be avoided at all costs because of those risks and should not be taken lightly.
Even surgeons counsel people of the risks (which are many) and also the chances are high that the surgery won’t work and yes, the very real risk of getting worse after the surgery has to be mentioned.
I was talking to one of my assistants a few days ago in the afternoon. I couldn’t remember on of my patients name. It happens. I admit it.
I said, “You know, he’s the one with the failed back surgery.” My assistant looked at me and said, “Dr. Currie, almost all of our patients have had failed back surgery. You’re going to have to give me more.”
Since am a natural doctor with non-invasive treatment protocols that I have developed over time, I meet and treat so many patients who share their tearful stories of failed surgery.
I work my best to help my patients get their quality of life back so that they can hopefully avoid going down that road. Thankfully, my patient satisfaction rates are high and my protocols help most people.
My treatment protocols center around relieving nerve pressure and improving health of the disc space (cushion between the bones) so that the nerves have more room and don’t conduct abnormal sensations.
My laser treatments help decrease inflammation of the nerves and bring in fresh oxygen and nutrients while flushing out cellular debris and toxins. Additionally, they help create energy production in the cells so that they can get better much faster than what they would be able to do on their own.
If you have big toe symptoms of numbness or some of the other symptoms I talked about in this article, it is really important that you take action and do something about it.
The sensory pathway is the one that you are noticing. It is what has your attention. But, how are your motor pathways are being affected? Are you having pain or cramping in the back of your thigh or the side of your calf muscle?
Are you starting to experience some weakness or balance problems? Do you have muscle atrophy (shrinking of muscles) which can be a sign of permanent nerve damage?
Do you have what is most likely permanent nerve damage in the form of foot drop and you have to wear a brace in your shoe to keep from tripping when you walk?
Like I said, the sensory side of the nerve is what is getting your attention but once the motor pathway is gone, it’s usually gone and will never come back.
Health is Happiness,
Dr. Keith Currie