Pain When Lifting Toes: Common Causes and Treatment

Pain when lifting your toes, a motion doctors call dorsiflexion, usually points to a problem in or around the metatarsophalangeal (MTP) joints at the ball of the foot. The most common culprits are ligament sprains (turf toe), arthritis of the big toe joint (hallux rigidus), sesamoid bone injuries, and nerve irritation. Because several different structures are loaded every time you pull your toes upward, the specific location, timing, and quality of the pain matter a great deal for narrowing down the cause.

Turf Toe and Plantar Ligament Sprains

Turf toe is one of the most recognized injuries that causes sharp pain with toe extension. It is a sprain of the plantar complex beneath the big toe’s MTP joint, where a thick ligament, two small sesamoid bones, and the joint capsule all work together to stabilize the toe against the ground during push-off. The injury happens when the big toe is forced into extreme upward bending, usually while the forefoot is planted and a load drives the toe beyond its normal range. In a study of 80 professional football players with turf toe, roughly 85 percent sustained the injury through this hyperextension mechanism.¹

You do not need to be a professional athlete to get turf toe. Dancers, hikers, and weekend runners can all experience it, especially in flexible footwear that lets the forefoot bend freely. The hallmark symptom is pain at the base of the big toe that flares when you actively lift the toe or push off during walking. Swelling on the ball of the foot and bruising underneath are common. Mild sprains (grade 1) tend to respond to rest, taping, and stiff-soled shoes that limit toe bending. More severe sprains that involve a torn plantar plate may need weeks in a walking boot or, in some cases, surgical repair to restore the joint’s push-off stability.²

The injury is often underestimated because the joint looks small and the initial pain can seem minor. But turf toe damages the same structures that let the big toe bear as much as twice your body weight during running. Ignoring it can lead to chronic stiffness, ongoing pain with any toe extension, and early arthritis of the joint.³

Hallux Rigidus and Big Toe Arthritis

If the pain with toe lifting has been creeping in gradually rather than starting with a single event, hallux rigidus is a strong possibility. This is arthritis of the big toe’s MTP joint, and its name literally means “stiff big toe.” As the cartilage wears down, bone spurs grow along the top of the joint. Those spurs physically block the toe from bending upward, and attempting to force the motion produces a deep, aching pain at the top or sides of the joint.

In milder stages, the pain tends to come and go with activity, and you might notice a bony bump on top of the joint that rubs against your shoe. As it progresses, loss of motion becomes more pronounced and daily walking gets uncomfortable because normal gait requires the big toe to bend upward by at least 45 to 65 degrees during push-off. Surgical approaches for milder cases focus on removing the excess bone spurs (a cheilectomy) to clear a path for the toe to bend upward, sometimes combined with an osteotomy to shift the available range of motion into a less painful arc.⁴ Before surgery, many people get meaningful relief from rocker-bottom shoes, which reduce how much the toe needs to bend during walking, or from stiff shoe inserts that offload the joint.

Sesamoid Injuries

The two sesamoid bones embedded in the tendons beneath the big toe are roughly the size of corn kernels, but they play an outsized role in distributing force during walking and running. These bones can develop stress fractures from repetitive loading, particularly in runners and dancers. Pain from a sesamoid stress fracture is felt under the ball of the foot and characteristically worsens when the big toe is pulled upward (dorsiflexion), because that movement compresses and stretches the tissue around the fractured bone. The pain typically disappears with rest and returns with activity.⁵

Sesamoiditis, an inflammation of the sesamoid bones without an actual fracture, produces a similar pattern. Distinguishing between the two usually requires imaging. Treatment for sesamoid problems tends to be conservative: offloading pads, reduced activity, and occasionally a period of immobilization. Sesamoid fractures that do not heal can become chronic and frustrating, sometimes requiring surgical removal of the affected bone.

Nerve-Related Causes

Two nerve conditions can produce pain or abnormal sensations when you lift your toes, but they feel quite different from joint and bone problems.

Morton’s Neuroma

Morton’s neuroma is a thickening of the tissue around one of the small nerves that runs between the long bones of the forefoot, most often in the space between the third and fourth toes or the second and third toes. It is not actually a tumor; it is fibrosis caused by repeated pressure or irritation of the nerve.⁶ The classic complaint is a burning or shooting pain in the ball of the foot that radiates into the affected toes, often described as stepping on a pebble. Tight shoes make it worse, and some people feel the pain sharpen when curling or lifting their toes because the movement shifts the metatarsal heads and compresses the swollen nerve. First-line treatment includes wider shoes, metatarsal pads placed just behind the painful area, and sometimes corticosteroid injections. Surgical excision of the thickened nerve segment is reserved for cases that do not improve.

Anterior Tarsal Tunnel Syndrome

The deep peroneal nerve runs across the top of the foot beneath a band of tissue called the extensor retinaculum. If that nerve gets compressed there, you develop anterior tarsal tunnel syndrome, a relatively uncommon condition that produces pain, tingling, or numbness on the top of the foot and the web space between the big and second toes. Lifting your toes can aggravate it because the tendons that dorsiflex the toes slide beneath the same retinaculum, and the movement can push against the already-squeezed nerve. Tight shoes and lacing patterns that press down on the top of the foot are frequent contributors. Nerve conduction studies confirm the diagnosis by showing slowed signals through the deep peroneal nerve at the ankle. Surgical decompression of the tunnel relieves symptoms when conservative measures fail.⁷

Gout and Inflammatory Arthritis

When pain with toe lifting is accompanied by sudden, dramatic swelling and redness, an inflammatory condition like gout deserves early consideration. Gout famously targets the big toe’s MTP joint, and during a flare the joint becomes so sensitive that even a bedsheet draped over it can be excruciating. Between acute flares, chronic gout gradually changes foot mechanics. People with gout in the big toe joint show measurably less dorsiflexion range of motion compared to people without the disease.⁸ That reduced motion makes lifting the toe painful and stiff even when the joint is not acutely inflamed.

Psoriatic arthritis is another inflammatory condition that can cause toe pain with dorsiflexion. It often involves “sausage-like” swelling of an entire toe (dactylitis) rather than isolated joint inflammation. Unlike gout, psoriatic arthritis tends to affect multiple joints and may be accompanied by skin or nail changes. Both conditions are treatable with medications that target the underlying inflammation, so getting an accurate diagnosis is valuable rather than just managing pain.

When the Problem Is in the Spine, Not the Foot

This catches many people off guard: pain or weakness when lifting your toes can originate from a pinched nerve in your lower back, not from anything in the foot itself. The L5 nerve root, which exits the spine between the fourth and fifth lumbar vertebrae, is primarily responsible for powering the muscles that pull your toes and foot upward. A herniated disc at the L4/L5 level can compress this nerve, causing pain that radiates down the leg and into the top of the foot, along with difficulty or weakness in dorsiflexing the toes.⁹

If you notice that lifting your toes has become weak rather than just painful, and especially if you also have back pain or tingling running down the outside of your lower leg, the spine is worth investigating. The condition known as foot drop, a noticeable difficulty clearing the toes from the ground while walking, is a more advanced sign of L5 nerve root compromise. It is easy to assume the problem must be where the pain is felt, but referred pain from the lumbar spine is common enough that clinicians routinely check for it during foot evaluations.

The Role of Shoes and Lacing

Sometimes the culprit is external. Shoes that are too tight across the top of the foot create direct pressure over the extensor tendons and the nerves that run beneath them. Research on dorsal foot pressure during running shows that the highest pressures under the shoe tongue concentrate over the talus bone, the navicular bone, and the first ray, which is the line of bones leading to the big toe.¹⁰ Reducing pressure over those spots is associated with better comfort, and adjusting your lacing pattern can help. Skipping an eyelet over a tender spot, using a “window lacing” technique, or simply loosening the lower portion of the laces can make a meaningful difference.

High-heeled shoes alter foot mechanics in a different way. They push weight forward onto the ball of the foot and force the MTP joints into greater extension, which can aggravate turf toe, hallux rigidus, sesamoid irritation, and Morton’s neuroma all at once. If you notice toe-extension pain mainly while wearing certain shoes, the shoes themselves are a reasonable place to start troubleshooting before assuming a more serious structural problem.

Getting the Diagnosis Right

Because so many different structures can cause pain with dorsiflexion, accurate diagnosis matters more than for many musculoskeletal complaints. A physical exam that reproduces the pain by pushing the toe upward is helpful but does not distinguish between a joint sprain, early arthritis, a sesamoid problem, and an inflamed tendon, all of which can hurt in the same general area with the same maneuver.

Standard X-rays are a reasonable first step and can show bone spurs (hallux rigidus), sesamoid fractures, and joint-space narrowing. But they miss soft-tissue injuries and early inflammation. Ultrasound and MRI are considerably more sensitive to inflammatory and destructive changes in the small joints of the toes. In studies comparing imaging methods, ultrasound and MRI detected pathology that X-rays and clinical exam missed, with good agreement between the two advanced modalities for bone changes and moderate agreement for inflammatory findings.¹¹ Ultrasound has the advantage of being quick, relatively cheap, and done in the office. MRI is better for complex cases or surgical planning.

For suspected nerve problems, nerve conduction studies and electromyography can pinpoint whether a nerve is compressed and where. And when gout is suspected, joint aspiration (pulling fluid from the joint with a needle) remains the gold standard, because finding urate crystals under a microscope gives a definitive answer.

Treatment Approaches

Treatment depends entirely on the underlying cause, but a few principles apply broadly. For most mechanical and overuse problems, relative rest, appropriate footwear changes, and anti-inflammatory measures (ice, oral NSAIDs) are the sensible first steps. Rigid or rocker-bottom shoe inserts are particularly useful because they reduce the demand on the MTP joint to bend during walking, which is exactly the motion that provokes pain.

Corticosteroid injections are widely used for conditions like Morton’s neuroma, hallux rigidus, and sesamoiditis. They can provide meaningful short-term relief, though they are not a permanent fix. In a study of foot and ankle corticosteroid injections, about a quarter of patients went on to have surgery within the follow-up period, and roughly one in seven needed a repeat injection.¹² That does not mean injections are ineffective; for many people they bridge the gap while other treatments (physical therapy, orthotics, activity modification) take hold. But they work best as part of a broader plan rather than as a standalone solution.

Physical therapy focuses on restoring range of motion, strengthening the intrinsic foot muscles, and correcting gait patterns that may be overloading the affected area. For inflammatory conditions like gout and psoriatic arthritis, disease-specific medications (urate-lowering therapy for gout, disease-modifying drugs for psoriatic arthritis) address the root cause and can prevent progressive joint damage. Surgical options, from cheilectomy for hallux rigidus to nerve decompression for tarsal tunnel syndrome, are reserved for cases that fail conservative care.

Children and Adolescents With Toe Pain

Growing feet have their own set of vulnerabilities. Several conditions unique to children and adolescents can produce pain during toe movement, including Freiberg’s disease (a condition where the end of a metatarsal bone loses blood supply and partially collapses, typically in the second toe), sesamoiditis, and accessory navicular syndrome.¹³ Freiberg’s disease tends to strike teenage girls more often and causes pain at the ball of the foot that worsens with push-off and toe extension. It is sometimes mistaken for a simple metatarsal stress reaction, but imaging reveals the characteristic flattening and irregularity of the metatarsal head.

Because children’s bones are still developing, growth plates are vulnerable to injury in ways that adult bones are not. The sesamoid bones beneath the big toe do not fully ossify until the mid-to-late teens, so a painful sesamoid in a teenager could represent a growth-plate stress injury rather than a fracture through solid bone. The good news is that most pediatric foot conditions respond well to activity modification, supportive footwear, and patience as skeletal maturity catches up.

Why Toe Extension Matters for Walking and Running

Understanding why pain with toe lifting is so functionally disruptive comes down to how your foot works during the push-off phase of gait. As you step forward and your heel rises, your toes bend upward against the ground. This motion tightens the plantar fascia through a mechanism called the windlass effect, stiffening the arch and converting the foot into a rigid lever for push-off. The intrinsic muscles of the foot play a critical role here. Research using nerve blocks to temporarily disable these muscles found that when the small muscles within the foot could not contract, the distal joints of the foot could not be stiffened enough to provide normal push-off against the ground during late stance.¹⁴

This explains why even mild pain with dorsiflexion tends to change the way you walk. People unconsciously shorten their stride, reduce their push-off force, and shift weight to the outside of the foot to avoid bending the painful toe. Over time those compensations can create secondary problems, including calf tightness, knee discomfort, and even hip or low-back pain. Addressing the toe issue early, rather than just adapting your gait around it, helps prevent that cascade from developing.