Persistent pain at base of big toe

About 5 months ago, I cranked on a marginal, smeary knee bar hard enough to injure my big toe over the course of a 30-60 second rest. Since that time, I've had low-level pain in the base of the big toe joint; it doesn't prevent any activities but is exacerbated by climbing on small foot holds and is worse the next day after high volume climbing.

I went to a podiatrist a few weeks after the onset of the pain. He took an x-ray and cleared me for duty, saying there was nothing identifiably problematic, just a bit of inflammation.

Anyone had a similar experience? Specifically looking for rehab exercises; otherwise I'm off to a different, and hopefully more helpful, podiatrist. 

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Where on the joint? Can you be more specific? I had persistent pain in the big toe joint on the inner side of the joint for months. I don’t remember there being an obvious incident when the pain started. Nothing the podiatrists suggested did anything for me. eventually I realized that wearing narrow shoes seemed to set it off. I retired my katanas and haven’t had an issue since.

The podiatrist I saw diagnosed it as inflammation of one of the major nerves of the toe. This is diagram is pretty much spot on.

Interesting, thanks for your response. Seems like the same spot -- inside of the big toe (adjacent to the 2nd toe, not on edge of the foot). Maybe a touch forward from where the star's drawn.

Don't believe this is related to a specific set of shoes, but this is a helpful clue, perhaps.

Check out "Turf Toe". My partner was just diagnosed with that after having a smeary foot slide during a fall

Wrap  with lambs wool .That has worked on my arthritic right big toe for many years .

+1 to turf toe. I got it from wearing no-midsole slippers and climbing a lot of slab. Stiffer shoes helped the recovery.

Could also be gout.  If you eat a lot of red meat and drink your share of beer, it could be gout.

Sesamoiditis is worth looking in to- you have 2 little knee cap like bones under your great toe that can get irritated.  It can present pretty much as you describe OP.  

I have suffered from when now seems like a multitude of foot ailments over my 20+ yrs in climbing shoes.  The other pain that could explain your pain is a non-typical Morton's Neuroma, pretty much what Jack Lange describes. I've had to have both of these issues addressed via surgery, in opposite feet, first in 2015 and then 2022.   Both a first digit neuroma and a lateral sesamoiditis can present as pain on the bottom of the foot, sort of in between the big and second toes near the first toe joint.  Nerve pain often feels different than soft tissue inflammation, but for example, my neuroma did not have typical nerve pain sensations and felt much more like some bursitis.

Foot injuries are a total drag.  It's hard to find ways to heal.  It's hard to say no to day-to-day activities that you enjoy but should opt out of while you are trying to get your feet back in good shape.  I hope you find some relief.  

Shop around for a good Podiatrist.  It took me 3 attempts to find someone I really trusted.  If they only ordered an x-ray and no MRI or other way to assess soft tissue inflammation I think your current provider is lacking.

I have a similar pain — worst when climbing on small holds, then it moved to not being able to bend the big toe at that joint (walking was not great). For inflammation (that showed on MRI) I got cortisol shots. That didn’t help and I had to have surgery — I somehow ripped a part of cartilage in that joint.. still in recovery nearly 4 mo later. 

try drinking 2oz of pure tart cherry juice for a few days gor some it relieves non-clinical gout symptoms 

also bi weekly rotate foods and change diet to non inflammatory foods 

pull straight out firmly on that big toe once a day 

get street sized rock shoes and wear injinji toe socks and put a thin layer of wool fibers in shoe under big toe ball

And the winner is...Andy Shoemaker for suggesting a podiatrist. A second opinion is a good idea. 

Runner-up is the not yet suggested orthopedist.

How much did you downsize your shoes from street? Are they a reverse last?

If it was gout you would know it because you’d likely be in the ER seeking pain meds. Gout pain is intense and relatively short lived (a few days of shocking pain and then the flare wears off). Unless you’re in the latter stages of the disease, but you would already know it if that were the case.

Sesamoiditis doesn’t present in the joint of the toe, but at the base where your foot makes contact with the ground. I’ve been lucky enough to experience both, unfortunately.

Agreed, doesn’t sound like gout. 

Tl;dr: try different shoes.

Specific incident leading to onset of pain most likely an injury to a nerve, joint, tissue, etc. is most likely.

Turf toe definitely a possibility. Some rehab could assist with this recovery. To me it sounds like it’s not specifically this, however.

I’ve dealt with a lot of similar issues. Regarding my toes, similar to the first response, I have retired all my La Sportiva shoes. The lasts are far too narrow for my wide forefoot, and creates immediate pain for me, despite previous years of climbing with them up to that point w/o issue. I’ve had good results switching my footwear, personally wider lasts are mandatory for me to address this concern.

Interesting that this seems to be shoe-specific for some people. My toe also becomes irritated from an uphill hike in comfy approach shoes on non-climbing days, and my right foot is unaffected, so I don't think it's shoe specific. 

Sounds like I'm back to check out a different podiatrist.

Thanks for this discussion.  I was about to post my own issue but this thread has both justified my suspicions and made me feel a little better in that there are some solutions (switching to a wider toe box, etc.  I have been strictly free heel skiing since the early 90's and I had an initial flare up after a hut trip two winters ago and since then I have had intermittent swelling and flare up episodes, a couple of them completely incapacitating.  X-ray diagnosis was (arthritis).    No redness or complete screaming kind of pain so I can't imagine it is gout.  But maybe someone out there has been diagnosed with gout and not had redness?  The point tenderness is not on top or bottom but on the medial side of the joint.  I suspect sesamoiditis but it is so easy to go down the self diagnosis rabbit hole these days with all the info online.  Yeah, stuffing my feet into climbing shoes could be part of my problem but why was skiing the trigger.  

I just tried to post this and MP asked me if I wanted to resurrect the topic.  Whatevs.  I think all of these opinions are helpful to fellow sufferers.  Cheers!

Ivan Locke wrote:

I just tried to post this and MP asked me if I wanted to resurrect the topic.  Whatevs.  I think all of these opinions are helpful to fellow sufferers.  Cheers!

So I’ve had sesamoiditis on and off since high school (I’m almost 50 now) and I finally fractured my sesamoid in a climbing fall a few years ago, around the same time I was also diagnosed with gout. The pain and swelling are somewhat similar, but a true gout flare is much worse; I’ve only had two gout attacks and it’s a “lie in bed and grit your teeth” kind of pain. I had to turn the ceiling fan off in my bedroom, because any air flow over my foot actually hurt. Prior to my first real flare, I now believe (in hindsight) that I had some mini-flares going back several years. I used to think it was from crack climbing, but my big toe joint would get very sore and it would cause me to limp, and climbing hurt enough that I would take a week or two off. Almost no swelling or redness, just a very sore joint. This happened at least 2-3 times in the years leading up to my first real flare.

Sesamoiditis should present as pain/tenderness on the bottom of your foot, not the side. Google some photos of foot anatomy and you should actually be able to palpate the sesamoid bones, they are about the size of a pea (most people have two of them) and if it’s your sesamoid, it will feel tender when you apply pressure to that bone (again, on the bottom of your foot, not the side).

Gout usually presents with classic symptoms, so if you do some online research and suspect you might have it, I’d strongly recommend you request an arthrocentesis, a procedure where they stick a needle deep into the toe joint to extract some of the fluid and look for urate crystals. This is the only conclusive test for gout, and it kinda sucks but it’s over quick. If you have gout, you’re going to want to know because it’s a treatable form of arthritis that can be really debilitating as you age, especially if it goes unmanaged. Let me know if you have any questions on that topic, I sincerely hope you don’t have it!!