Dr. Collins: If you're active, here's a possible cause of toe pain

It is often said that the feet are ignored until they scream. Given the stresses they put up with, it is amazing they don't speak up more often.

Toes are stepped on all day and never complain - until they start to wear out from constant pounding on the trail or in the gym. The result can be a condition called hallux rigidus, and it usually develops slowly.

When the condition gets bad enough, even simple walking can cause quite a bit of pain. I see it often at this time of year in patients as they increase their running mileage. In winter, it can be brought about by telemark ski boots.

The joint in the toe where spurs, called osteophytes, develop is at the base of the big toe. Reach down and feel your big toe. There is one joint just behind the nail and another larger one where the toe seems to connect to the foot. The larger one is where arthritis sets in and spurs can form.

If you play with your big toe at that joint you will see that it can move up and down through a large range, but has little motion from side to side. This fits with the action of the toe during walking. It has to move up and down to allow the body to move forward.

We don't know what causes the joint at the base of the great toe, called the MTP (meta tarsal phalangeal) joint, to undergo degenerative arthritic change, but one theory is that repetitive hits from living an active life can accentuate the wear on this joint.

The end result is a joint that starts to lose its cartilage layer and develops spurs on the top and the bottom. The spurs on the top can get large enough to prevent the big toe from moving up and cause pain and swelling.

You will see this when you try to lunge forward on your feet with the foot bent at the toe-foot junction. This motion is most evident when you are running up a steep hill or when you get down for a tight telemark ski turn.

In a tele-turn you ask your foot to bend to the maximum at the toe joints, and any limitation there will cause pain if you have hallux rigidus.

Alpine ski boots don't usually ask the toes to move like this so they can be easier on a foot. This condition is, however, a cause of foot pain with many sports and may be overlooked. Here are some signs and symptoms:

Pain in the great toe joint when you are active, especially if you need to push off with your toes.

Swelling in and around the great toe joints, especially on the top.

A bump or callus on the top of the foot at the big toe joints.

In early stages, there may be pain at night after a hard day on the hill or a long run.

Treatment starts with simple things like rest, ice and anti-inflammatory medicines. These will not cure this condition, so don't use medication to help you "play through the pain."

A contrast bath can help, too. A contrast bath uses alternating cold and hot water to reduce inflammation. Take two buckets, one with water as cold as you can stand and another with water as warm as you can take. Move your foot from one bucket to the other, allowing about 30 seconds in each for a total of five minutes or so. You should finish the session in the cold bath. Don't do this in public because it looks pretty weird.

The first thing to look at for a long-term fix is to get a larger toe box on your shoe or boot. This should work for a while. If the condition gets worse you can go to shoes and boots that have a stiff sole. Running shoes with a rocker sole can help.

Alpine ski boots are better than telemark gear since they don't bend in the sole. If you are a backcountry telemark skier and have been limited with hallux rigidus, consider getting alpine boots and switching over to randonnee gear. It will allow you to climb without hurting the toes.

If these measures don't provide enough relief, or if the condition worsens, you may need surgery.

You can alter your activities and footwear to accommodate and hopefully prevent the need for surgery. Preventing trauma to the foot may help too, so use a night light if you need to get up at night and give your feet a rest from hitting the wall.

Paul Collins, M.D., is an orthopedic surgeon specializing in sports medicine at Orthopedic Health Care in Boise. Collins is an avid participant in many of Idaho's outdoor activities. Send your sports medicine questions to outdoors@idahostatesman.com or to the Idaho Statesman, P.O. Box 40, Boise, ID 83707.