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Toe Pain at Night

Toe Pain at Night

Did you know that something as minor as toe pain at night could be a symptom of underlying medical conditions, like peripheral neuropathy? Read on...
Scholasticus K
Last Updated: Mar 14, 2018
Pain in the toes could be a symptom of certain underlying medical conditions, that may vary in severity and nature. The causes can range from something as simple as an ingrown toenail, to serious ones, like peripheral neuropathy. Toe pain may be accompanied with other symptoms like, swelling, numbness and tingling, burning sensation, etc. It can be persistent, recurrent or occasional. In some cases, the severity of the pain may vary throughout the day and worsen during night. Aggravated toe pain during night is usually associated with certain underlying causes.
What Causes Toe Pain at Night
Toe pain can be caused by medical conditions that involve the toe either directly or indirectly. For instance, a bunion is a condition that affects the big toe joint, whereas tarsal tunnel syndrome involves the tarsal tunnel that is located near the ankle bone. Pain in the toes is a symptom that is common for both these conditions. Apart from carpal tunnel syndrome, ingrown toenail, and bunion, toe pain at night could be a symptom of gout, peripheral neuropathy, hallux rigidus and Morton's neuroma. The underlying causes may vary from one person to another. So a basic understanding about the common causes and their symptoms may prove useful in identifying the condition.
Gout - caused by high uric acid levels in the blood - affects the joints
The Toe Connection: Gout is characterized by inflammation and pain in the joints. One of the typical symptoms of gout is the sudden and excruciating pain (mostly) in the big toe, during the night. The area in and around the affected joint will develop inflammation, sometimes, along with fever. The skin of the affected toe turns red and shiny. The inflammation and other symptoms last for a few days. Once the swelling subsides, the skin starts peeling off.

Treatment: Medication like NSAIDs, pain killers, and corticosteroids are usually prescribed. In some cases, medicines for lowering the uric acid levels may also be required. Certain lifestyle changes are also recommended for those with gout. The affected person has to reduce intake of meat, fatty foods, and foods rich in purines. Gradual weight loss is also suggested, for those who are overweight.
Peripheral Neuropathy - damage to the peripheral nerves - affects the nerve functions
The Toe Connection: The symptoms of peripheral neuropathy may vary with the type of nerve(s) affected. The early symptoms are numbness, tingling, and pain in the feet and hands. So pain and numbness in the toes are commonly experienced during the initial stages of peripheral neuropathy. Such toe pain can be sharp and throbbing, accompanied with a burning sensation. These symptoms are often experienced at night. In short, such toe pain at night could be an indication of peripheral neuropathy. Diabetes is cited as the most common cause for this medical condition.

Treatment: The treatment is mainly aimed at the underlying cause. For example, diabetics should control their blood sugar levels, so as to get relief from the symptoms of peripheral neuropathy. Maintaining a balanced diet and addressing any vitamin deficiency, may also prove beneficial. Medication like pain killers and antidepressants are usually prescribed. Surgical intervention may be required, especially in case of nerve entrapment. So the treatment may not be the same for all.
Tarsal Tunnel Syndrome - compression of the tibial nerve - affects the foot
The Toe Connection: The compression of tibial nerve, as it passes through the tarsal tunnel (a narrow passage that lies next to the ankle bone) may cause symptoms like, numbness, tingling, and pain, in the foot. The symptoms are more concentrated near the ankle, but may also radiate to the toes. The condition may also cause swelling, and may be accompanied with prickling and burning sensation. The symptoms may worsen at night. Repetitive stress is the most common cause of tarsal tunnel syndrome, which is also seen in obese people and those with flat feet.

Treatment: Pain killers and NSAIDs are prescribed to relieve inflammation and pain. Some people may require steroid injections too. Physical therapy and use of orthotic devices may prove beneficial. Application of ice is one of the home remedies to alleviate the symptoms. If there is no relief, surgery may be suggested.
Hallux Rigidus - degenerative arthritis of the big toe - affects the big toe joint
Symptoms: The condition can be caused by repeated stress on the big toe joint. An injury to the toe may also trigger hallux rigidus. Sometimes, medical conditions like gout could be the contributory factor. As the condition affects the big toe joint, it causes pain and stiffness of the big toe. The joint may also develop swelling. Formation of bone spurs or calluses, is also not uncommon. Cold and damp weather is one of the factors that can worsen toe pain caused by hallux rigidus. The symptoms may also worsen during nighttime.

Treatment: The condition is usually treated with NSAIDs and/or corticosteroids for reducing the pain and inflammation. Avoid strenuous activities that exert pressure on the toe. Wear shoes that have enough room for the toes to move. Surgical intervention may be required, for removal of bone spurs or for repositioning of the concerned toe cartilage.
Morton's Neuroma - thickening of nerve tissues in the ball of the foot - affects the forefoot, toes
Symptoms: The condition is characterized by thickening of nerve tissues that are found in the ball of the foot. Mostly, such thickening affects the nerve that travels between the third and fourth toes. The symptoms include pain in the ball of the foot and the toes. Such pain will be accompanied with numbness, tingling, and burning sensation. The pain may not subside during night or with rest.

Treatment: Corticosteroid injections are administered to resolve the swelling of the nerve. Use of custom-made orthotics may help to reduce the pain and associated symptoms. Surgery is often considered the last resort. A surgical procedure is either aimed at resolving the compression of the nerve, or to remove the nerve itself. The second method may sometimes result in permanent numbness of the toes.
Ingrown Toenail - Nail edges grow into the skin - affects the toes
Symptoms: As the name rightly suggests, the condition refers to the growth of toenail into the skin. The most common causes are constant use of ill-fitting footwear, improper trimming of the nails and nail infections. The big toe is found to be commonly affected by this condition. The symptoms include toe pain, redness, and swelling of the affected area.

Treatment: Consult a podiatrist, who may either try to lift the affected nail and trim it, or remove that part of the nail that has grown into the skin. In case of second method, the procedure is done, after numbing the toe. Another method is to remove the ingrown part of the nail, along with the nail bed, so that the condition does not recur.
Bunion, Hammer Toe, Corns and Calluses
  • Bunion: A deformity, in which the big toe bends towards the second toe, so that the outer edge of the big toe joint protrudes in the opposite direction, forming a bumpy projection. The symptoms include pain in and around the big toe joint, along with swelling and soreness.
  • Hammer toe: This is a condition that affects the second, third and the fourth toes. The middle joint of the toe bends downward, so that the toe looks like a hammer. The symptoms include toe pain and corns or calluses on the toe joints.
  • Corns and Calluses: They are nothing other than an accumulation of dead skin cells, formed by repeated exposure to pressure and friction. While calluses may not cause any symptom, corns (calluses with a conical shape) are usually found to cause pain and discomfort.
Though toe pain is common for all the three conditions, the intensity and nature of the pain may vary. The pain may be persistent or intermittent. It may or may not subside during nighttime.
This is only a brief overview about the common causes of toe pain at night. While some of these medical conditions cause sudden and excruciating toe pain, particularly at night, others may cause persistent or intermittent pain that may or may not extend till night. In case you develop such toe pain, consult a healthcare professional and get it diagnosed and treated.
Disclaimer: This article is for informational purposes only and should not be used as a replacement for expert medical advice. Visiting your physician is the safest way to diagnose and treat any health condition.