The normal function of peripheral tissue depends on normal blood supply to provide nourishment and oxygen to the tissue and organs. Similarly, normal function depends on exchange of sensory, motor and autonomic signals from and to spinal cord from peripheral receptors. Receptors lies over the surface of peripheral tissue and organs. The normal function of upper and lower extremities involves muscle contraction, joint movements and feeling of harmful sensation by skin. The lack of adequate blood supply or malfunction of peripheral nerve to the foot or big toe can cause numbness of the big toe.

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Consult Physician- Big toe numbness is instant or slow in occurrence. Anytime if you feel numbness in big toe then you should see primary care physician or specialist as soon as possible.

Blood Supply To Big Toe-

The arterial blood carries the nourishment and oxygen to the peripheral tissue like big toe. The branches of first metatarsal artery supplies 80% of the arterial blood and first plantar metatarsal artery supplies 20% of the blood.1

Nerve Supply To Big Toe-

The spinal nerve carries sensory and motor nerves to the peripheral tissue. The sensory nerve carries signals of touch, temperature and pain from skin, muscles, tendon, ligaments, joints, cartilages and bones to the spinal cord. Spinal nerve also carries signals from brain and spinal cord to the muscles so the muscle contracts and assist joint movement. In addition to sensory and motor nerves there are autonomic nerves known as sympathetic and parasympathetic nerves. These nerves originate in spinal cord as well as sympathetic ganglion. Autonomic nerves follow the arteries to the big toe. Sympathetic nerve causes narrowing and parasympathetic nerve causes dilatation of arteries and its branches. The branch of spinal nerve known as superficial peroneal nerve carries sensory and motor nerve to the foot and big toe. The branch of superficial peroneal nerve that supplies sensory and motor nerve to big toes is known as dorso-medial cutaneous nerve.2

Numbness in big toe is the condition that usually occurs when there are abnormalities in the circulatory system or peripheral nervous system. It is important to know the causes of numbness in big toe, so proper treatment is provided to treat the cause of pain.

Causes of Numbness in Big Toe

Causes of Numbness in Big Toe

The numbness is caused by abnormal function of peripheral sensory nerve. The temporary numbness is reversed when cause of numbness is removed. The abnormal function of sensory nerve causes pain, tingling, numbness and inability to understand the position of extremity as well as joint. Such abnormal function of branches of sensory nerve to big toe is caused by nerve injury or lack of blood supply to nerve and sensory receptors. Sensory receptors lie on surface of tissue like skin, muscle, tendon, ligament, cartilage, joint capsule and bone. The lack of blood supply or injuries to these tissue causes damages to sensory receptors that results in numbness and pain.

    1. Restricted Peripheral Blood Circulation– The condition is also known as peripheral vascular disease (PVD). In most of the cases, the flow of blood to the feet gets restricted. Sitting or standing in awkward position, keeping the feet in wrong direction etc. can restrict the blood flow and is one of the causes of numbness in big toe. Although it subsides on its own, but if it persists, the condition needs to be elevated.

Causes of Restricted Peripheral Blood Supply and PVD-

Peripheral vascular disease (PVD) causes narrowing of the peripheral blood vessels. Peripheral vascular disease is frequently observed in individual suffering with following risk factors:

Age-

Peripheral blood supply is reduced in elderly.3

Smoking-

Chronic smoking causes peripheral vasoconstriction and also peripheral hypoxia. Peripheral hypoxia is caused since hemoglobin carries less oxygen molecules. Smoking also causes abnormal endothelial function and platelet function.4

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Obesity-

Obese patient frequently suffer with peripheral vascular disease. The possible cause of Peripheral vascular disease (PVD) in obese patient is hypertension, dyslipidemia and hyperglycemia (increase blood sugar)5

Diabetes-

Diabetes causes peripheral vascular diseases. The cause of PVD observed in individual suffering with diabetes are endothelial dysfunction, vascular smooth muscle cell dysfunction, mucosal inflammation and hypercoagulability.6

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Deep Vein Thrombosis and Peripheral Embolism-

Deep vein thrombosis of veins in lower leg restricts the blood flow through the peripheral veins. The condition causes ulcers and tissue trauma that frequently damages peripheral nerve fibers and receptors. Such effects causes numbness of big toe.

    1. Vitamin B12 Deficiency – Vitamin B12 takes care of smooth functioning of the nervous system. One of the main causes of numbness in big toe can be a deficiency of vitamin B12, which can also lead to a tingling sensation.7

    2. Lumbar Radiculopathy – Lumbar radiculopathy is caused by pinch of spinal nerve in lower spinal segment. Pinch of 4th and 5th lumbar nerve causes numbness of big toe.8 The symptoms of such condition (lumbar radiculopathy) is pain, numbness and weakness in muscles. The nerve is pinched by disc bulge, herniation, spinal stenosis and foraminal stenosis.

    3. Peripheral Nerve Injury- Peripheral nerve injury is caused by penetrating injury and blunt trauma. Such injury is observed in automobile accident as well as work and sport injury. Nerve injury may be associated with dislocation of joints of big toe or fracture of metatarsal and phalangeal bone. A bad pair of shoes can be responsible for causing numbness in toes.9 Bad pair of shoes can put unnecessary pressure on the peripheral nerve that lies over the surface of toe. Such pressure can cause irritation or pinch of peripheral nerve. Such injury may result in numbness and pain. Similarly, Bunion is basically the bump that occurs at the base of the big toe. These bumps cause extreme pain in toe and sometime it can lead to numbness in the big toe.

Causes of Peripheral Nerve Injury:-

    1. Sport injury
    2. Automobile injury
    3. Work injury
    4. Domestic fall
    5. Shoes
    6. Bunion
  1. Diabetic Neuropathy – Diabetes causes peripheral neuropathy and autonomic neuropathy.10 This is the condition that affects sensory nerve and causes peripheral sensory nerve damage. The condition causes numbness of foot and big toe.

  2. Gout – In many cases gout is overlooked, but it can be one of the cause of numbness in big toe. When the level of uric acid increases in body, then uric acid crystals deposits in the small joints. Such effect causes swelling of joint and ulceration. Ulceration causes adjacent sensory nerve damage resulting in numbness.11

  3. Raynaud's Disease – This is a medical condition that hampers the supply of blood to toes and fingers. The symptoms of this condition include pain, tingling sensation and numbness in big toe. Raynaud’s disease causes peripheral vasoconstriction, narrowing of peripheral arteries and tissue damage such as peripheral tissue gangrene. The peripheral tissue damage and lack of adequate blood supply causes peripheral sensory nerve damage.12

Treatment for Numbness in Big Toe

The best treatment options for numbness in big toe depends on the underlying causes. Seeking timely medical opinion and following medical advice is essential.

Some of the treatment options include:

    1. Diabetes- Diabetes should be treated with oral antidiabetic pills or insulin depending on level of blood sugar. The fasting and after food (post-prandial) blood sugar must be maintained within normal level to prevent and reversed complication like peripheral neuropathy.
    2. Treatment to Reverse B12 Deficiency- B12 neuropathy is treated with diet and pills. Daily intake of B12 pills help to decrease or reverse the symptoms of big toe numbness.
    3. Peripheral Vascular Disease- Treatment involves surgery and medications. Medications prescribed are vasodilator to improve blood circulation.
    4. Gout- Gout is treated with medications like Colchicine, NSAIDs and Prednisone.
    5. Raynaud’s Disease-
      1. Medications- Raynaud’s disease is treated with medication, surgery and nerve block.

        1. Calcium Channel Blocker- Pills or oral medications prescribed for dilatation of arteries are Calcium channel blocker (Nifedipine, Felodipine and Amilodipine)

        2. Peripheral Vasodilator- The vasodilator (Cozaar, Revatio, Prozac and Sarafem) is prescribed to treat constriction of peripheral arteries that is frequently observed in Raynaud’s disease.

      2. The Sympathetic Ganglion Block- Sympathetic nerve impulses or signals causes constriction of peripheral blood vessels that supplies blood to great toe. Sympathetic ganglion block stops or reduces such signals and causes vasodilatation that improves blood supply to big toe.

      3. Surgery- Surgery performed to improve blood flow the big toe is sympathectomy. Surgery involves excision of sympathetic ganglion and nerve.

    6. Lumbar Radiculopathy- Following treatment is recommended for big toe numbness when the numbness is caused by lumbar radiculopathy.

      1. Medication- Severe pain not responding to NSAIDs and tylenol is treated with opioids. Opioid treatment is carefully observed to prevent addiction and dependence. Muscle spasm is treated with muscle relaxants. Following medications are recommended for numbness associated with pain.

        1. NSAIDs- Motrin, Naproxen and Celebrex
        2. Tylenol
        3. Opioids- Hydrocodone, Oxycodone, Morphine and Methadone.
        4. Muscle relaxants- Baclofen, Soma and Flexeril.
      2. Physical Therapy- Physical therapy is advised if big toe pain is associated with muscle atrophy or muscle paralysis.

Interventional Therapy- Pain and numbness caused by pinch or irritation of spinal nerve is treated with epidural steroid injection.

    1. Surgery- Numbness of big toe when caused by disc bulge, disc herniation, foraminal stenosis and spinal stenosis is treated with following surgical treatment.

    1. Discectomy
    2. Laminectomy
    3. Foraminectomy
    4. Spinal fusion surgery
  1. Smoking- Big toe numbness caused by smoking is treated with discontinuation of smoking. Quit smoking works in 9 to 12% of chronic smoker. Other treatment recommended to stop smoking are Zyban, Chantix and counseling.

  2. Obesity- Obesity is treated with weight reduction therapy.

  3. Treatment of Bunion- If bunion is the underlying cause of numbness, the doctors will recommend wearing square-shaped shoes and socks that don't have seam as it can alleviate the numbness and tingling in big toe. Corrective surgery is a treatment option for numbness in big toe only when the condition worsens.

References:  

  1. Arteries to the great and second toes based on three-dimensional analysis of 100 cadaveric feet. Hamada N1, Ikuta Y, Ikeda A., Surg Radiol Anat. 1993;15(3):187-92.
  2. Origin and course of the dorsomedial cutaneous nerve to the great toe. Miller RA1, Hartman G., Foot Ankle Int. 1996 Oct;17(10):620-2.
  3. Peripheral arterial disease in the elderly Wilbert S Aronow, Clin Interv Aging. 2007 Dec; 2(4): 645–654.
  4. The relationship of cigarette smoking to peripheral arterial disease. Lu JT1, Creager MA., Rev Cardiovasc Med. 2004 Fall;5(4):189-93.
  5. Obesity and peripheral arterial disease: A Mendelian Randomization analysis. Huang Y1, Xu M1, Xie L2, Wang T1, Huang X1, Lv X1, Chen Y1, Ding L1, Lin L1, Wang W1, Bi Y1, Sun Y3, Zhang Y4, Ning G1., Atherosclerosis. 2016 Apr;247:218-24.
  6. Diabetes and peripheral vascular disease. Huysman E1, Mathieu C., Acta Chir Belg. 2009 Oct;109(5):587-94.
  7. Nutritional Neuropathies Nancy Hammond, MD, Yunxia Wang, MD, Mazen Dimachkie, MD, and Richard Barohn, MD, Neurol Clin. 2013 May; 31(2): 477–489.
  8. Peroneal neuropathy misdiagnosed as L5 radiculopathy: a case report Michael D Reife1,2 and Christopher M Coulis3,4,5, Chiropr Man Therap. 2013; 21: 12.
  9. Bunions: Overview Created: June 28, 2018; Next update: 2021 https://www.ncbi.nlm.nih.gov/books/NBK513134/
  10. Diabetic neuropathy V Bansal, J Kalita, and U K Misra, Postgrad Med J. 2006 Feb; 82(964): 95–100.
  11. Ulcerated tophaceous gout Michelle Gita Filanovsky,1 Kumar Sukhdeo,2 and Megan Cunnane McNamara3, BMJ Case Rep. 2015; 2015: bcr2015210707.
  12. Raynaud Disease (Raynaud Phenomenon, Raynaud Syndrome) Rina Musa; Ahmad Qurie., Creighton University School of Medicine

Also Read:

Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: June 27, 2019

This article does not provide medical advice. See disclaimer

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