Pain guide · Foot pain

Big toe pain: arthritis, a bunion, gout, turf toe, the sesamoids, an ingrown toenail or a break

Big toe pain usually comes from the main joint at the base of the toe, the two small sesamoid bones underneath it, or the nail. Where it hurts and how it started tell the causes apart: a stiff joint with a bump on top points to arthritis, a lump on the side with the toe drifting to a bunion, sudden hot, red, swollen pain, often overnight, to gout, pain underneath when you push off to the sesamoids, and redness at the side of the nail to an ingrown toenail.

This guide starts with the signs that need help today, from a 999 call or accident and emergency (A&E) to the National Health Service's 111 line (NHS 111) or a general practitioner (GP): a toe that may be broken, a hot, swollen joint with a fever, and any new foot problem if you have diabetes. It then maps the causes, sets out what helps (the right shoes, stiff soles and inserts, and why gout isn't only about food and drink), and gives a three-stage plan that ends with walking, push-off and running.

3-stage exercise plan When to get help 38 sourcesUpdated 24 October 2026

When to get help first

Exercise is for pain that has been checked or is clearly mild and settling.

Get urgent medical help if

Call 999 or go to A&E: after an injury, you heard a crack, the foot or ankle has changed shape or points at an odd angle, a bone is sticking out, there is a bad cut over it, you're in severe pain, or the toes look blue or white, feel numb or are cold to touch. These can mean a broken bone. Don't drive yourself.
Go to A&E if you think you have broken your big toe, the toe is pointing at an odd angle, the bone is sticking out, you feel tingling in your toe or foot or it feels numb, or your child has hurt or broken their toe. Ask someone to drive you or call 999 for an ambulance.
Call 999 or go to A&E: a foot or leg that is suddenly cold, pale, numb, weak or very painful without an injury. A sudden loss of blood supply is a vascular emergency.
Call 999 or go to A&E: you have diabetes and a foot ulcer with a fever or signs of sepsis, an ulcer with poor circulation, or gangrene. The National Institute for Health and Care Excellence (NICE) asks for these to go straight to hospital.
Call 999 or go to A&E: a red, hot, swollen foot with a very high temperature, feeling hot, cold or shivery, a fast heartbeat or fast breathing, purple patches on the skin, dizziness or confusion.
Contact NHS 111 if you have badly hurt your big toe, you're in severe pain, you feel faint, dizzy or sick from the pain, you have any tingling or loss of sensation in your foot, you heard a snap, grinding or popping noise at the time of the injury, you have difficulty moving your toes or you cannot walk, or you have toe pain and feel hot, cold or shivery.
Same day: a sudden, very painful, hot, swollen, red joint, often the big toe but sometimes the middle of the foot (the midfoot) or the ankle, especially with a high temperature, feeling shivery or being unable to eat. It may be gout, but it could be a joint infection (septic arthritis), which is urgent.
Same day: you have diabetes and a new foot problem, such as an ulcer or wound, signs of infection, or a hot, swollen foot with a change in colour, even if it doesn't hurt. Contact your diabetes foot team or GP: NICE asks for these to reach a specialist foot service within 1 working day, and a suspected Charcot foot is kept off weight until it has been checked.
If you have diabetes, see your local foot team urgently, within 24 hours, for a change in the colour or shape of your foot (especially a red, hot, swollen toe, ankle or foot), part of your foot feeling much colder or hotter than usual, new blisters, cuts or wounds (especially ones you can see but don't feel), a cut or wound that smells bad or is leaking fluid or pus, or new or unexplained pain in your foot. Meanwhile sit or lie down, take the weight off it and raise it.
Contact a GP immediately (or NHS 111 if you can't): burning foot pain that carries on at rest, toes that go pale, then numb, then red or black, or foot wounds that won't heal. The blood supply to the foot may be failing.
Same day: skin on the foot that is painful, hot and swollen. It could be a skin infection (cellulitis).
A child's stubbed big toe that bleeds from around the nail, or whose nail has lifted out of its fold: it can be a break through the growth plate that is open to the outside and needs antibiotics. Take them to an urgent treatment centre or A&E straight away.
Same day (NHS 111): toe pain with feeling hot, cold or shivery, or a cut near the injured toe that becomes red, hot, swollen or starts to ooze. These can be signs of an infection.
Same day (urgent GP appointment or NHS 111): throbbing pain in one leg (rarely both), usually the calf or thigh; swelling in one leg (rarely both); red, blue or darkened skin around the painful area, which may be harder to see on brown or black skin; or swollen veins. It could be a blood clot in a deep vein (deep vein thrombosis, DVT). Watch for it after an ankle injury or time in a cast or boot.

See a doctor or physiotherapist if

See a GP if you think you might have broken a toe, the pain is stopping you doing normal activities, it is getting worse or keeps coming back, it hasn't improved after 2 weeks of treating it at home, or you have diabetes and foot pain. You may be able to refer yourself to a podiatrist.
See a GP if you have symptoms of gout for the first time, or your usual gout treatment isn't helping.
See a GP if treating an ingrown toenail at home isn't helping, your toe is painful and swollen with pus coming out of it, you have a very high temperature or feel hot, cold or shivery, or you have diabetes and an ingrown toenail.
See a GP if bunion pain hasn't improved after a few weeks of home treatment, is stopping your normal activities, or your bunions are getting worse, or if you have bunions and diabetes.
See a GP if the pain and swelling haven't started to ease 5 days after you injured your toe, or it still hurts to walk 6 weeks after it. They may send you for an X-ray.
See a GP if you have diabetes and have injured your toe: foot problems can be more serious if you have diabetes.
After a turf toe, a big toe joint that feels loose or unstable, weak push-off, or a big toe that starts drifting towards the other toes (a new or worsening bunion) or cocking up: see a GP or physiotherapist. These can mean a complete tear, a damaged sesamoid bone or a loose fragment, which may need a surgeon's opinion.
Pain in one spot under the big toe joint that hurts with every step and later at rest or at night, especially after a rise in training: a possible stress fracture of a sesamoid, which heals slowly. Take the load off it until it has been checked.
Tingling or loss of feeling in the foot, or a foot that feels weak.
A cut or sore on your foot that isn't getting better, or blisters or cracked skin on your feet if you have diabetes: see a GP or your diabetes nurse.
See a GP if chilblains aren't getting better after 2 to 3 weeks, there's pus coming out, you have a very high temperature or feel hot, cold or shivery, you keep getting them, or you have diabetes.
Joint pain, stiffness and swelling that keep coming back, or a swollen toe or finger: see a GP, even if you don't have psoriasis. It can be psoriatic arthritis, which a specialist (a rheumatologist) treats.

Where does it hurt?

Location narrows the likely causes; it does not diagnose.

A stiff, painful big toe joint, often with a bump on top, worst as you push off when walking, usually from 30 to 60

Big toe arthritis (hallux rigidus), the commonest arthritis in the foot.

Read: Big toe arthritis →A hard, bony lump on the side of the joint, the big toe drifting towards the others, worse in shoes and when walking

A bunion (hallux valgus).

Read: Bunions →

Sudden, severe pain in the big toe joint, often overnight, with hot, red, swollen skin, so sore even the bedclothes hurt

Often gout: a first attack needs a GP. With a high temperature or feeling unwell, it could be an infection: see the warning signs. Our exercise with gout guide covers exercise between flares.

Under the big toe joint on the ball of the foot, building up gradually, worse pushing off, on tiptoe, dancing or running

The sesamoids (sesamoiditis).

Read: Sesamoiditis →One spot under the joint that hurts with every step and later at rest, or pain straight after the toe was forced back

A possible sesamoid fracture: take the load off it and get it checked.

Read: Sesamoiditis →Pain, swelling and bruising at the base of the big toe after it was bent back with the heel off the ground, in field sports or dance

Turf toe, a sprain of the big toe joint.

Read: Turf toe →

Red, swollen, painful skin at the side of the nail, the nail curving into the toe, sometimes with pus

An ingrown toenail: warm, salty soaks and wide shoes, and see a GP or podiatrist if it isn't settling.

After a stub, a kick or something dropped on it: bruised, swollen and painful to walk on

A possible broken toe. Go to A&E if you think you've broken your big toe.

Read: Broken toe →

Itchy, burning, red or purple patches on the toes a few hours after being cold, or toes that change colour in the cold

Chilblains or Raynaud's. Our exercise with Raynaud's guide covers keeping warm when active.

Tingling, numbness or burning in the big toe, with back or buttock pain or pain down the leg

A nerve from the lower back, which NHS inform says can cause foot symptoms even without back pain.

Read: Sciatica →

Burning, tingling or numbness in both feet

Nerve damage in the feet (peripheral neuropathy), most often from diabetes: see a GP. Our exercise with peripheral neuropathy guide covers staying active safely.

Burning or tingling in the web between the big toe and the second toe, worse in tight shoes or boots

A squeezed nerve on top of the foot.

Read: Pain on top of the foot →

A swollen, sausage-like toe, with psoriasis or other swollen joints

Possibly psoriatic arthritis: see a GP.

With diabetes: any new pain, a wound, or a change in colour, shape or temperature, even if it doesn't hurt

See your foot team urgently, within 24 hours.

Under the ball of the foot at the base of the second toe, the toe drifting or lifting

A plantar plate tear (the second toe, not the big toe).

Read: Plantar plate tear →Burning or shooting pain between the third and fourth toes, like a pebble in your shoe

Morton's neuroma.

Read: Morton's neuroma →Big toe or ball of foot pain mainly when you run

Our foot pain when running guide.

Read: Foot pain when running →Big toe or ball of foot pain mainly when you walk

Our foot pain when walking guide.

Read: Foot pain when walking →

Understand it

Where it hurts is a clue, not a diagnosisStrong evidence

The NHS toe pain page sorts the causes by what you notice: sudden pain, stiffness and hot, swollen or red skin around the toe joint points to gout; a painful, swollen or bruised toe that hurts to walk on to a sprain or a break; and it lists ingrown toenails, bunions, chilblains and Raynaud's too. NHS inform adds that foot problems can come from the back even when your back doesn't hurt, felt as pins and needles, or sharp, hot or burning pain.

So this guide says a spot points to a cause rather than proving it, and an examination decides.

Sources 1, 2

A stiff, painful joint: big toe arthritisStrong evidence

The American Academy of Orthopaedic Surgeons (AAOS) calls big toe arthritis (hallux rigidus) the most common arthritic condition in the foot, usually from 30 to 60: pain on top of the joint when walking, trouble pushing off, a bump and stiffness, linked to wear, old injuries, foot shape and genes. In a survey of adults aged 50 and over in four UK general practices, painful arthritis of the big toe joint on X-rays was estimated in 7.8%, more in women and with age.

Arthritis UK says the big toe is the foot joint most commonly affected by osteoarthritis, and a review says a turf toe that was never recognised can lead to a stiff, arthritic joint later.

Sources 3, 4, 5, 6

A lump on the side: a bunionStrong evidence

Across 76 surveys of almost half a million people, bunions (hallux valgus) affected 23% of adults aged 18 to 65 and 36% of over-65s, 30% of women and 13% of men. The NHS describes a hard lump on the side of the foot by the big toe, the toe pointing towards the others, and pain worse in shoes and when walking, and says badly fitting shoes may make bunions more likely (a page past its review date). The AAOS says the pain comes from shoe pressure over the bump.

Sources 7, 8, 9

Sudden, hot, red and swollen: goutStrong evidence

Gout affects about 2.5% of the UK population, more men and older people, and the big toe joint is where it most often strikes; an attack peaks within 12 to 24 hours and settles in 1 to 2 weeks, a UK review says, and only a minority of people with a high urate level get gout. The National Institute for Health and Care Excellence (NICE) suspects gout with rapid onset, often overnight, of severe pain with redness and swelling in one or both big toe joints.

Arthritis UK says about three-quarters of the urate in your body comes from purines your body makes itself, and only about a quarter from food and drink, and inherited ways the kidneys handle urate are a common cause. The NHS lists family history, being a man, excess weight, alcohol, the menopause, some medicines, high blood pressure, kidney problems and diabetes, and triggers such as alcohol, a large meal, dehydration and an injury (a page past its review date).

Sources 10, 11, 12, 13

Under the joint: the sesamoids, and turf toeStrong evidence

Two small bones under the big toe joint, the sesamoids, act as pulleys for the tendons that bend the toe. The AAOS says sesamoiditis builds up gradually under the ball of the foot and is common in ballet dancers, runners and baseball catchers, while a sesamoid can break with sudden pain after the toe is forced back, or from repeated stress.

Turf toe is a sprain of the big toe joint when it is forced upwards with the heel off the ground, graded 1 to 3 by how badly the tissue under the joint is torn. A review says it is relatively rare and easily missed.

Sources 14, 15, 6

The nail, the cold and the skinStrong evidence

An ingrown toenail usually affects the big toe: red, painful, swollen skin at the side of the nail as it curves in, and pus if it becomes infected, the NHS says; the AAOS says tight shoes and cutting the nail too short are the usual causes. Chilblains are itchy or burning, red or purple patches on the toes a few hours after being cold, and they usually clear in 2 to 3 weeks.

Sources 16, 17, 18, 1

Diabetes, nerves and the circulationStrong evidence

Diabetes UK says raised blood sugar can damage the small blood vessels and nerves in the feet, so you may not feel an injury and wounds can heal slowly, and a minor problem such as a blister can quickly become a serious infection or ulcer. NICE asks for an active diabetic foot problem to reach a specialist foot service within 1 working day, and suspects a Charcot foot, where the foot's joints break down, with redness, warmth, swelling or a change of shape even without pain.

Peripheral neuropathy, nerve damage that usually starts in the feet, causes numbness, tingling or burning (an NHS page past its review date), and the NHS asks people with diabetes to see a GP or diabetes nurse about blisters or cracked skin on their feet. Psoriatic arthritis can cause a swollen toe (an NHS page past its review date).

Sources 19, 20, 21, 22, 23

When a scan or test helpsStrong evidence

Big toe arthritis is diagnosed from an examination and X-rays, which show the spurs and the narrowed joint. Gout is diagnosed from the story and the examination and confirmed by a blood urate level of 360 micromol per litre or more, repeated at least 2 weeks after the flare if it was lower; a typical big toe attack can be recognised clinically, and fluid from the joint or a scan helps if it's still unclear. In a hot, red, swollen joint, an infection has to be ruled out first.

Turf toe needs X-rays to rule out a small break or a sesamoid out of place, with a magnetic resonance imaging (MRI) scan for the worse grades. A sesamoid problem gets X-rays first, sometimes of both feet because in some people a sesamoid is normally in two parts, then a bone scan or MRI if the X-ray is normal. A broken toe often needs no X-ray, but a suspected broken big toe goes to A&E.

Sources 3, 12, 10, 11, 24, 15, 14, 25, 26

How it usually goesEmerging evidence

An untreated gout attack usually lasts 1 to 2 weeks, and untreated gout can come back more often and damage the joint. Most broken toes heal in 4 to 6 weeks, sometimes several months. A mild turf toe often allows play in a stiff-soled shoe, a moderate one usually needs 3 to 14 days' rest and a severe one weeks of protection. Sesamoid problems can take weeks or months, though most settle without surgery. Chilblains usually clear in 2 to 3 weeks.

Big toe arthritis and bunions are long-term: shoes and exercise ease the pain, and surgery is the option when pain still limits your walking. No one can promise a date.

Sources 11, 25, 15, 14, 18, 3, 8

What helps, and how strong the evidence is

Shoes and inserts that stop the joint bendingEmerging evidence

In 100 people with big toe arthritis, carbon-fibre inserts that stiffen the shoe reduced foot pain more than sham inserts at 12 weeks, by 6.66 points on a 100-point scale, and 61% against 34% said they had improved overall: about 1 extra person helped for every 4 treated, though the pain difference was small and some people won't notice a worthwhile change. In 102 people, ready-made foot orthoses and rocker-sole shoes eased pain by similar amounts; the orthoses were worn more and had fewer side effects.

The AAOS suggests a shoe with a large toe box and a stiff sole with a rocker or roller bottom, or a stiff carbon-fibre insert, to reduce how far the joint bends.

Sources 27, 28, 3

Arch-shaped insoles: probably no better than shamsStrong evidence

A Cochrane review of 6 trials with 547 people found that arch-shaped foot orthoses probably make little or no difference to big toe arthritis pain compared with sham insoles (moderate certainty). Single trials of stiffening inserts and a joint injection were too small and at risk of bias to be sure.

Source 29

The SIMPLE home routine: gentle, but untested on its ownEmerging evidence

In the SIMPLE trial, everyone with big toe arthritis did a home routine: a heat pack for 10 minutes, 2 minutes of gentle self-mobilisation of the big toe joint (easing the toe away from the foot and gliding it), 10 holds of 10 seconds pressing the big toe down, then a cold pack for 10 minutes, daily for 12 weeks and then three times a week. Because both groups did it, its own effect is unknown; it is given in the written steps below as a gentle routine, not a proven cure.

Source 30

Gout: medicines treat and prevent flares; a special diet doesn'tStrong evidence

For a flare, NICE recommends an anti-inflammatory painkiller, colchicine or a short course of steroid tablets, alongside ice packs, and offers urate-lowering medicine to people with repeated flares, kidney disease, gout lumps (tophi) or long-term gouty arthritis, aiming to keep urate below 360 micromol per litre. NICE says there isn't enough evidence that any specific diet prevents flares or lowers urate, advises a healthy, balanced diet, and says excess weight and too much alcohol may make flares worse.

Between flares, the NHS advises regular exercise, avoiding intense exercise or a lot of pressure on the joints, a healthy weight without crash dieting, alcohol-free days and plenty of fluids (a page past its review date). Our exercise with gout guide covers this in more detail.

Sources 12, 11, 13

Bunions: comfort, not correctionMixed evidence

A review of 18 studies found the evidence for non-surgical bunion treatments was low certainty, and less pain was more likely than a straighter toe. The NHS suggests wide shoes with a low heel and soft sole, bunion pads and ice, says you can't get rid of a bunion or stop it getting worse yourself, and offers surgery for pain that affects your life, not for looks; recovery takes weeks, with no sport for 3 to 6 months. The AAOS says roomier shoes relieve the pain in most cases.

Sources 31, 8, 9

Ingrown toenails: surgery stops them coming backEmerging evidence

Across 24 trials with 2,826 people, surgical treatments prevented an ingrown toenail coming back better than non-surgical ones; in one trial, adding phenol to removing part of the nail cut regrowth problems from 41% to 14%. The trials had unclear risks of bias. The NHS says start with warm, salty soaks, keeping the foot dry and wide shoes, and see a GP if that isn't helping; a podiatrist can remove part or all of the nail under a local anaesthetic.

Sources 32, 16

Turf toe and the sesamoids: protect, then rebuildStrong evidence

For turf toe, the AAOS describes rest, ice, compression and raising the foot, taping and a stiff-soled shoe, and says physiotherapy should begin as soon as symptoms allow, because early joint movement helps prevent stiffness; most turf toe is treated without surgery. For the sesamoids, it describes stopping the activity that hurts, a cushioning pad, low-heeled shoes, taping the toe slightly downwards and sometimes a brace for 4 to 6 weeks, and says most sesamoid problems settle without surgery.

Sources 15, 14, 6

How much pain is OK while you exercise?

The foot pain rule, with the gout, bone and numb-feet exceptionsEmerging evidence

This guide uses our foot pain guide's rule. Some discomfort during exercise is fine: aim for pain you would call mild to moderate, no more than about 5 out of 10, that settles within an hour, with no more swelling or stiffness the next morning. If it's worse the next day, do a little less (a smaller range, fewer reps, a lighter band), not nothing. The 5 out of 10 figure is an editorial starting point, not a tested rule; NHS inform's foot exercises use the same 0 to 5 limit, and say a stretch should feel gentle, not sore.

With big toe arthritis, NICE warns that joint pain may rise when you start exercising, but regular exercise will still help. Never force the toe back: calf raises stop short of full tiptoe, as the move page says. Under the joint, our sesamoiditis guide keeps pain to about 2 to 3 out of 10 (its editorial choice), and one sore spot on a bone that hurts with every step means stop and get it checked, as a sesamoid can break.

A hot, red, swollen gout joint isn't exercised: rest and raise it during the flare. If your feet are numb, pain won't warn you, so check your skin after exercise; with diabetes, a new wound, a colour change or a hot, swollen foot goes to your foot team, not the pain rule. In trials of long-lasting muscle and joint pain, exercise that allowed some pain did no worse than pain-free exercise.

Sources 33, 34, 14, 11, 19, 35

The exercise plan: 3 stages

Start at the first stage. Each move opens a full guide with a 3D demo.

Stage 1

Protect and calm it: shoes first, and keep the rest of the leg working

About the first 2 weeks, or while it is flared: wide, comfortable shoes with a low heel and a soft sole, with no high heels or tight, pointy shoes; rest and raise the foot; and ice wrapped in a towel for up to 20 minutes every 2 to 3 hours, unless you have chilblains or Raynaud's (the NHS). For big toe arthritis or a sore sesamoid, a stiff or rocker sole or a stiff insert that stops the joint bending. Gout, a suspected break, an ingrown toenail and diabetes go to the warning signs and the written steps first. Doses are editorial unless marked.

Ankle circles demonstrated on the 3D figure

3D demoAnkle circlesBeginner · No equipment

10 slow circles each way with each foot · The move page's dose, which it labels an editorial starting point; let pain set the size of the circle

Harder: Ankle CARs (controlled articular rotations)

Seated bent-knee calf raise (soleus raise) demonstrated on the 3D figure

3D demoSeated bent-knee calf raise (soleus raise)Beginner · A bench or box

2 sets of 10 to 15, with no weight on your knees · As in our broken toe guide (an editorial dose); only if pushing through the ball of the foot doesn't hurt the toe

Harder: Slow calf raise

Towel toe curl demonstrated on the 3D figure

3D demoTowel toe curlBeginner · Other / check instructions + A bench or box

2 sets of 10, gently · As in our big toe arthritis and broken toe guides (editorial doses); NHS inform's toe curl is a similar exercise. Curling the toes doesn't bend the big toe back; stop if it hurts

Easier: Big toe press (seated toe-flexor hold) · Harder: Short foot + toe splay

Wall calf stretch (gastrocnemius) demonstrated on the 3D figure

3D demoWall calf stretch (gastrocnemius)Beginner · A wall

3 holds of 30 s each side, with the big toe flat on the floor · As in our big toe arthritis and sesamoiditis guides; NHS inform holds stretches for 20 to 30 s

Easier: Seated calf stretch with a towel · Harder: Heel-on-step calf and hamstring stretch

Stationary cycling demonstrated on the 3D figure

3D demoStationary cyclingBeginner · Cardio machine

20 to 30 min, pushing through the arch or heel, in a stiff-soled shoe · As in our sesamoiditis and turf toe guides, so the big toe doesn't bend

Easier: Recumbent exercise bike · Harder: Air bike intervals

Glute bridge demonstrated on the 3D figure

3D demoGlute bridgeBeginner · No equipment

2 sets of 10 · As in our turf toe guide: strength for the rest of the leg without loading the toe

Easier: Pelvic tilt into bridge · Harder: Single-leg glute bridge

Move on when: You can walk in your chosen shoes with little pain and no limp, the swelling is going down, and the toe is no stiffer or more swollen the next morning (the foot pain rule; our turf toe guide's check).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 2

Strength and walking

About weeks 2 to 8: build calf and foot strength while the big toe stays flat or only part-way up, keep the shoe changes, and build up your walking. With big toe arthritis, keep the SIMPLE routine in the written steps going alongside. Doses are editorial unless marked.

Slow calf raise demonstrated on the 3D figure

3D demoSlow calf raiseBeginner · A wall

3 sets of 10 to 15, to half height · As in our big toe arthritis guide; with big toe arthritis or pain in the ball of the foot, stop short of full tiptoe (the move page)

Easier: Seated bent-knee calf raise (soleus raise) · Harder: Standing dumbbell calf raise

Tibialis raise demonstrated on the 3D figure

3D demoTibialis raiseBeginner · No equipment

2 to 3 sets of 10 · As in our big toe arthritis guide; your weight stays on your heels

Harder: Single-leg tibialis raise

3D demoTowel toe curlBeginner · Other / check instructions + A bench or box

3 sets of 10 to 20; add a light weight on the far end of the towel when it's easy · As in our turf toe guide

Easier: Big toe press (seated toe-flexor hold) · Harder: Short foot + toe splay

Single-leg stand demonstrated on the 3D figure

3D demoSingle-leg standBeginner · A wall

3 holds of 30 s each leg · As in our big toe arthritis and sesamoiditis guides; with numb feet, keep a hand on a counter (the move page)

Easier: Tandem stance and heel-to-toe walk · Harder: Single-leg reach matrix

3D demoStep-upBeginner · A step

3 sets of 8 each side, the whole foot on the step · As in our big toe arthritis and sesamoiditis guides

Easier: Low step-up · Harder: Dumbbell step-up

Treadmill walking demonstrated on the 3D figure

3D demoTreadmill walkingBeginner · Cardio machine

Build up your walking time, in your stiff or rocker-soled shoes · As in our big toe arthritis and sesamoiditis guides; walking outdoors counts

Harder: Treadmill jogging

Move on when: 15 half-height calf raises and 30 minutes of brisk walking cause no more than mild pain at the big toe, during or the next day, with no extra swelling (adapted from our sesamoiditis guide's check; editorial).

Follow along: a timer, a cue and the next move, one step at a time.

Stage 3

Push-off, running and sport

From about week 8, once the toe bends without sharp pain: push-off, then running and sport, by the written steps below. With big toe arthritis, keep the shoes that limit the bend and build up walking and other activity as comfort allows. After turf toe, a sesamoid problem or a break, that guide's checks and your team come first. Start running once 30 minutes of fast walking is pain-free (the NHS sports medicine service).

Single-leg calf raise from a step demonstrated on the 3D figure

3D demoSingle-leg calf raise from a stepIntermediate · A step + A wall

2 to 3 sets of 8 to 12 each leg, on flat ground first · As in our sesamoiditis guide; keep a hand on a rail (the move page)

Easier: Slow calf raise · Harder: Single-leg pogo hops

Plantar fascia stretch (seated) demonstrated on the 3D figure

3D demoPlantar fascia stretch (seated)Beginner · A bench or box

3 to 5 holds of 10 to 30 s, 2 to 3 times a day · The move page's dose. Only once the toe bends back without sharp pain, as our turf toe guide uses it; skip it with big toe arthritis, as the move page says to ease off if the big toe joint is stiff or painful

Harder: Toes-tucked kneeling (toe squat)

Heel raise with a towel under the toes demonstrated on the 3D figure

3D demoHeel raise with a towel under the toesIntermediate · A step + Other / check instructions

Every second day: a load you can lift about 12 times for 3 sets, building over weeks to heavier loads you can lift about 8 times · The move page's dose. Only once the toe bends back comfortably, as our turf toe guide says; not for big toe arthritis (our suggestion)

Easier: Slow calf raise · Harder: Standing dumbbell calf raise

Ankle bounces (mini pogo) demonstrated on the 3D figure

3D demoAnkle bounces (mini pogo)Beginner · No equipment

2 to 3 sets of 20, every other day · As in our sesamoiditis and broken toe guides (an editorial dose); not with a suspected stress fracture, and with numb feet choose low-impact options (the move page)

Harder: Pogo hops

Treadmill jogging demonstrated on the 3D figure

3D demoTreadmill joggingIntermediate · Cardio machine

The NHS walk-jog weeks, every other day · The NHS sports medicine service's programme, as in our broken toe guide; the weeks are in the written steps below

Easier: Treadmill walking · Harder: Sprint intervals

Move on when: Our suggestion: walking, running and your sport cause no more than mild pain at the big toe on the day or the next morning, and none at an old break or under the joint after a sesamoid problem; keep the shoe changes that helped. If big toe arthritis still limits your walking despite shoes and exercise, ask about an injection or surgery.

Follow along: a timer, a cue and the next move, one step at a time.

What to change for now

Shoes, nails and the toe (written steps)

Our 3D figure can't show these changes. They come from the NHS, the AAOS, Diabetes UK and a trial; where a step is our suggestion, it says so.

1. Most big toe pain: wide, comfortable shoes with a low heel and a soft sole, and no high heels or tight, pointy shoes (the NHS).
2. Big toe arthritis: a large toe box and a stiff-soled shoe with a rocker or roller bottom, or a stiff carbon-fibre insert, to reduce how far the joint bends (the AAOS); carbon-fibre inserts helped more people than sham inserts in a trial.
3. Under the joint: soft-soled, low-heeled shoes or stiff-soled shoes, a felt pad around the sore spot, and taping the toe slightly downwards (the AAOS). A bunion: wide shoes with a low heel and soft sole, and bunion pads (the NHS).
4. A broken toe: wide, comfortable, flat shoes with stiff soles; strap a smaller toe to its neighbour, but never strap the big toe yourself (the NHS).
5. An ingrown toenail: soak the foot in warm, salty water, keep it dry, wear wide shoes or sandals, and don't cut or pick at the nail; afterwards, cut nails straight across and not too short (the NHS).
6. Diabetes: check your feet every day, wear well-fitting shoes and go to your yearly foot check, and see your foot team within 24 hours for a new wound, a colour change or a hot, swollen toe (Diabetes UK).
7. Chilblains: keep your feet warm and dry, warm them up slowly after the cold, and don't scratch (the NHS).
8. Ice: wrapped in a towel, for up to 20 minutes every 2 to 3 hours, and not with chilblains or Raynaud's (the NHS).

Sources 1, 3, 27, 14, 8, 25, 16, 19, 18

The SIMPLE routine for big toe arthritis (written steps; no 3D demo yet)

From the SIMPLE trial's home routine, which both trial groups did, so its own effect is unknown. Skip it while the joint is hot, red and swollen, and ask your team first after recent foot surgery or a broken toe (the move pages for these two exercises).

1. Optional: warm the foot with a heat pack for 10 minutes, not on numb skin (the warmth is the trial's; the caution is our suggestion).
2. Sit with the foot across the other knee or on a stool, and hold the foot firmly just behind the big toe knuckle with one hand and the base of the big toe with the other.
3. Ease the toe gently away from the foot along its length, then, keeping that light pull, glide its base a little towards the top of the foot and back towards the sole in small, slow, comfortable movements. Finish by bending it gently up and down. Keep going for about 2 minutes.
4. Sit with both feet flat and the other toes long and relaxed, and press the big toe down into the floor without lifting the heel or the ball of the foot. Hold for 10 seconds, relax fully, and repeat 10 times.
5. Optional: a cold pack wrapped in a towel for 10 minutes.
6. Do it once a day for 12 weeks, then three times a week, as the trial did.

Source 30

Gout: during a flare and between flares (written steps)

From the NHS and NICE. Exercise isn't a treatment for a flare.

1. During a flare: take your treatment as soon as you can, rest and raise the foot, keep it cool, drink plenty of fluids, keep the bedclothes off it and don't put pressure on it (the NHS); NICE adds ice packs alongside the medicine.
2. A first attack needs a GP, and a hot, swollen joint with a high temperature or feeling unwell needs help the same day (the NHS).
3. Between flares: regular exercise, avoiding intense exercise or a lot of pressure on the joints, a healthy weight without crash dieting, and alcohol-free days (the NHS); our exercise with gout guide covers the details.
4. Ask about urate-lowering medicine if flares keep coming back (NICE).

Sources 11, 12

Walking, push-off and running come back (written steps)

No trial has tested how to bring these back after big toe pain as a whole. These steps are our suggestion unless a source is named.

1. Walking: build the time before the speed, in the shoes that helped; uphill and stairs ask more of the big toe, so add them last.
2. Running: start once 30 minutes of fast walking is pain-free. Every other day, jog 1 minute and walk 1 minute for 30 minutes in week 1, then jog 2 and walk 1, jog 4 and walk 1, jog 9 and walk 1, and jog 15 and walk 1, until you jog 30 minutes in week 6; move up a level after a week without pain and down a level with pain, then add no more than 10% a week (the OxSport leaflet).
3. Sport: keep the stiff insert or taping for training and matches after turf toe (the AAOS), and a cushioning pad after a sesamoid problem (the AAOS).
4. Big toe arthritis: if pain still limits your walking despite good shoes and exercise, the AAOS describes an injection and surgery as the next options.

Sources 36, 15, 14, 3

Positions to swap, and why

Habit or position	Why it matters	Instead
High heels and tight or pointy shoes	The NHS says don't wear them with toe pain or bunions.	Wide shoes with a low heel and a soft sole.
Thin, flexible shoes, flip-flops and barefoot walking with big toe arthritis, turf toe or a sore sesamoid	They let the joint bend; the AAOS says stiff or rocker soles reduce the bend (flip-flops and barefoot are our turf toe guide's suggestion).	Stiff-soled or rocker shoes, or a carbon-fibre insert.
Forcing the toe back: kneeling on tucked toes, deep lunges onto the toes, hard sole stretches	It pushes a stiff or sprained joint into its painful range, and the toes-tucked kneeling page says ease in with an arthritic big toe or pain in the ball of the foot.	Gentle self-mobilisation (the SIMPLE steps) and toe curls.Try: Towel toe curl
Full tiptoe raises with big toe arthritis or pain under the joint	The slow calf raise page says stop short of full tiptoe with big toe arthritis or pain in the ball of the foot.	Half-height raises, and seated calf raises.Try: Slow calf raise
Hopping, skipping and jumping with a sore spot under the joint or a possible stress fracture	The ankle bounces page says leave it out with a suspected stress fracture, and the pogo hops page says talk to a clinician first after a recent one.	Cycling, pushing through the arch.Try: Stationary cycling
Exercising or walking on a hot, red, swollen joint	It could be gout or an infection: rest, raise and cool it, and get help the same day with a fever.	Rest the foot during the flare; our exercise with gout guide between flares.
Cutting an ingrown toenail yourself or picking at it	The NHS says don't.	Warm, salty soaks and wide shoes, then a GP or podiatrist.
Strapping the big toe to the next toe yourself	The NHS says strap only a smaller toe, and go to A&E if you think the big toe is broken.	A&E for a suspected broken big toe.
New impact work or barefoot walking with numb feet	Pain won't warn you, and the bounce and jogging pages say choose low-impact options and check your feet afterwards.	Cycling, or walking in well-fitting shoes, with daily foot checks.Try: Stationary cycling
Expecting toe spacers or correctors to straighten a bunion	Less pain is more likely than a straighter toe, and the NHS says you can't get rid of a bunion yourself.	Wide shoes and pads for comfort; surgery for pain that affects your life.

Routines to follow

Foot and ankle strengthening routine: toes, arches, calves and balance

A 15-minute barefoot routine for stronger toes, arches, calves and ankles, finishing with balance. You need only a towel, a wall and a resistance band.

15 minBeginner11 movesA wall, Other / check instructions

Balance exercises routine

Balance practice in 10 minutes: tandem stance, single-leg stands, marches, heel walks, tree pose and floor transfers.

10 minBeginner7 movesA wall, A bench or box

Low-impact cardio workout (no jumping)

A 25-minute standing cardio circuit with no jumping: marching, step jacks, sit-to-stands, punches, step-ups and wall push-ups, with a seated option for most moves.

25 minBeginner9 movesA bench or box, A step

Chair exercises for seniors: a seated workout

A 20-minute seated workout for older adults who cannot stand for long: marching, leg and arm strength, posture, and sit-to-stands that lead back to standing.

20 minBeginner11 movesA bench or box, Something with weight

Easy cardio workout

A steady 30 to 45 minute cardio session at talk-but-not-sing pace: walk, cycle, row or cross-train, counting toward weekly activity guidelines.

40 minBeginner3 movesCardio machine, A wall

Arthritis exercise routine: a joint-friendly circuit

A 30-minute joint-friendly circuit built like the GLA:D and ESCAPE-pain programmes: a gentle warm-up, chair, step and band strength moves, balance, then stretches.

30 minBeginner14 movesA bench or box, A step

More moves for this area

Questions people ask

What causes big toe pain?

The commonest causes are arthritis of the big toe joint, a bunion, gout, the sesamoid bones under the joint, turf toe, an ingrown toenail and a stubbed or broken toe. Where it hurts and how it started usually tell them apart: a stiff joint with a bump on top, a lump on the side, sudden hot, red swelling, pain underneath, or redness at the nail.

How do I know if it's gout?

Gout usually starts suddenly, often overnight, with severe pain, heat, redness and swelling, most often in the big toe joint. See a GP the first time: a blood urate test confirms it, repeated after the flare if it's low. With a very high temperature, feeling sick or pain that is getting worse, get help the same day, as it could be a joint infection.

Is gout caused by diet?

Only partly. About three-quarters of the body's urate is made by the body itself, inherited ways the kidneys handle urate are a common cause, and NICE says no specific diet has been shown to prevent flares. Keeping to a healthy weight, cutting down on alcohol and, for many people, medicines that lower urate help prevent flares.

Can I exercise with gout?

Not on the joint during a flare: rest and raise it, keep it cool and keep pressure off it. Between flares, the NHS advises regular exercise, avoiding intense exercise or a lot of pressure on the joints; our exercise with gout guide covers the details.

What helps a stiff, painful big toe joint?

Shoes or inserts that stop the joint bending help most: a stiff or rocker sole, or a carbon-fibre insert, which helped 61% of people against 34% with sham inserts in a trial. Ordinary arch-shaped insoles did no better than shams. A gentle daily routine of toe mobilisation and toe presses, and an injection or surgery if these fail, are the other options.

Can exercises or toe spacers fix a bunion?

They may ease the pain but are unlikely to straighten the toe, and the NHS says you can't get rid of a bunion or stop it getting worse yourself. Wide shoes with a low heel and soft sole and bunion pads help, and surgery is for pain that affects your life, not for looks.

Why does the ball of my foot under the big toe hurt?

Pain under the big toe joint that builds up gradually and is worse pushing off is often sesamoiditis, common in dancers and runners. Low-heeled shoes with a soft or stiff sole, a pad and taping help, and an X-ray, then a scan if needed, checks for a break.

What is turf toe?

It's a sprain of the main big toe joint when the toe is forced upwards while the heel is off the ground. Treatment is rest, ice, taping and a stiff-soled shoe; a moderate sprain usually needs 3 to 14 days' rest before returning to play, and a severe one longer.

Is my big toe broken?

A broken toe is bruised, swollen and painful to walk on. The NHS says go to A&E if you think you've broken your big toe, it points at an odd angle or the bone is sticking out, and don't strap the big toe to the next toe yourself. Most broken toes heal in 4 to 6 weeks.

How do I treat an ingrown toenail?

Soak your foot in warm, salty water, keep it dry, wear wide shoes and don't cut the nail or pick at it; see a GP if that isn't helping, there's pus, or you have diabetes. A podiatrist can remove part of the nail, and surgery stops it coming back better than other treatments.

I have diabetes and my big toe hurts. What should I do?

See a GP, because foot problems can be more serious with diabetes. If the toe is red, hot or swollen, changes colour or shape, or there's a new wound or new pain, see your foot team urgently, within 24 hours.

Why does my big toe hurt at night?

Gout often comes on overnight, with sudden severe pain, heat and swelling in the joint. Burning, tingling or numbness in the toes, especially with diabetes, can be nerve damage, which needs a GP check, and bone pain that is constant or worse at night needs checking too.

Related exercise guides

Ankle and foot guide

Other pain guides

Sources

Exercise education, not a diagnosis or treatment plan. It is written from the guidelines and studies listed above; review by a clinician is pending. If your pain follows an injury, is severe, is getting worse, or comes with any warning sign listed on this page, get it assessed. Health disclaimer.