Painful Toes at Night: Causes and Relief
19th Mar 2024
Toe pain at night can be due to a variety of reasons including circulatory issues, where you have loss of circulation as well as conditions that are causing inflammation of the joints that may be either due to rheumatic conditions or generalised wear and tear.
It is important to find the underlying problem and you may need a vascular opinion if you find that your toes are becoming white and numb and that they cramp. If the pain is just due to inflammation then icing the feet and the toes carefully for 10 minutes prior to sleeping and then using a home sock and a pillow under your feet would allow the swelling to reduce.
Understanding the Cause of Painful Toes
Painful toes can be related to some serious conditions such as poor blood circulation in which there is narrowing of the arteries that go towards the lower half of your leg and the feet. You should see a vascular surgeon if this is suspected and may need specialised scans. Other reasons may be damage to the nerves, especially in diabetic patients that due to uncontrolled diabetes and opinion from the diabetologist in terms of the overall diabetic care may need to be obtained.
| What You Experience | What It May Indicate | Surgery Required |
| A pulsating discomfort in your big toe during the night | Gout flare-up or bunions | Bunion Surgery |
| A burning feeling in your toes | Nerve-related issues such as neuropathy or Morton’s neuroma | Morton’s Neuroma Surgery |
| A sharp, piercing pain localized in one area | Ingrown toenail or a compressed nerve | Ingrown Toenail Surgery |
| A red, swollen, and sensitive toe | Gout attack, infection such as cellulitis or big toe arthritis | Cheilectomy procedure
for big toe arthritis |
| A tingling or numb sensation in your toes | Nerve damage (neuropathy) or complications related to diabetes | Non surgical treatment may include:
– change of footwear – orthotics or insoles |
| Pain that intensifies after walking | A stress fracture or sesamoiditis | Non surgical treatment may include:
– mobilising boot – Injections |
| Stiff, painful toes upon waking | Arthritis (either osteoarthritis or rheumatoid arthritis) | Cheilectomy procedure for big toe arthritis |
| Sudden, severe pain that disrupts your sleep | Gout or an acute infection | Non surgical treatment may include:
– Blood test and dietry management for gout. – Antibiotics for infection |
| Discomfort when moving your toes | Tendonitis or inflammation of the joint (capsulitis) | Tendon repair |
| Cold, painful toes at night | Poor blood circulation or Raynaud’s phenomenon | Non surgical treatment may involve:
– Referral to vascular surgeon |
Other causes such as injuries and inflammation can be managed through rest and appropriate use of footwear to protect your feet.
Treatment & Care
The treatment and care required would very much depend on the symptoms and the underlying disease causing the pain in the toes.
A common problem may be circulatory, which may be general circulatory diseases such as atherosclerosis of the blood vessels that supply the lower limbs. This will result in a condition called intermittent claudication, where you’d get cramps in the calves, feet, legs, and toes. This needs urgent investigation with Doppler ultrasound, and you may need to see a vascular surgeon to determine whether there’s anything to be done to improve the circulation.
The more benign conditions are pain in the toes related to chilblains or frostbite. This may be either due to the feet being cold at night or poor circulation, even for conditions such as Raynaud’s disease. If you have chilblains, then certain chilblain creams can help. It may take a few weeks before the tissue is relieved. Essentially, this tissue at the tip has injury due to lack of circulation. Wearing warm socks at night and avoiding massive transitions of temperature from hot to cold can also help.
Conditions such as gout can also cause significant onset of pain at night where the foot swells, and this is due to hyperuricaemia. The uric acid crystals embed themselves in the big toe joint, and often patients complain of sudden onset swelling of the big toe. In terms of tests, you will need uric acid blood tests. You will need anti-inflammatories such as colchicine for a short course or may even need steroid injections. You need to also investigate the underlying cause of gout, which may be dietary or genetic. You may often be referred to a rheumatologist for this as well.
Other reasons for big toe joint pain at night or big toe throbbing may be due to osteoarthritis. This is because you use the foot all day and the inflammatory process due to the degeneration of the big toe joint is causing some of the symptoms. Again, a specialist would either look at performing steroid injection, investigating with MRI and X-ray prior to that. Surgery, such as cleaning the joint, fusion, or joint implant of the big toe joint may be indicated.
When Should I See a Healthcare Professional for My Painful Toes at Night?
If the pain is persistent and is present for more than a week then Mr Nazir would recommend that you see a healthcare specialist and try to identify the underlying possible causes which may be a mixture of diabetes and poor circulation or an injury. You may need a specialised scan or investigations of your general health to determine the underlying cause.
Find Out More
If you have any other questions or would like to reserve an appointment at our practice, don’t hesitate to get in touch with our team: