Big Toe Pain During Golf


Big toe pain during golf

Pain through the big toe during a round of golf can be debilitating and stop you in your tracks. If you are a competitive golfer it could mean the end of a tournament. If you are a recreational golfer you might be forced to stop the round early or at the very least you will have a very unenjoyable round. If left untreated, this can turn into arthritis of the big toe joint or lead to other more serious ailments. In this article I will go over some common causes of big to pain that occurs during golf, how this pain could affect your game, and how to treat the pain.

Common causes

1. Extension of big toe

Golf swing showing push-off of back foot

The most common cause of big toe pain is due to excessive extension of the big toe during the follow through of the golf swing. Take a right handed golfer as an example. During the down-swing you will begin to rotate the back foot slightly and as the swing progresses to the follow through you will be applying even greater force through the right forefoot with significant pressure being placed through the right big toe. The follow through is when the big toe will be placed into the extreme of extension which over time can wear down the ligaments, muscles, and joints around the big toe. If left untreated this can lead to arthritis of the big toe. Again if the arthritis is left untreated it can progress to Hallux limitus which can then progress to the more serious Hallux rigidus. Both are described more below.

2. Long time spent walking and standing

Golfers walking

During a round of 18 holes the average golfer can expect to take 12,000 steps give or take 1,800 if they are walking. If that isn’t enough to let you know that golf can be great exercise, check out this article- Is Golf Good Exercise? 12,000 is a lot of steps and to put it into perspective the recommended number of steps to take per day for overall cardiovascular health is just 10,000. During every step we take there is a period of plantarflexion of the forefoot as we push-off that foot. This causes the big toe to be put into extension as well. If there is already some damage and inflammation of the big toe than taking 12,000 steps will only make it worse as every step will put further pressure on the big toe.

3. Spiked shoes

Golf spikes

Having spiked shoes can place increased pressure through the forefoot and subsequently the big toe. While simply having spiked shoes may not lead to any big toe problems they can exacerbate the problem once it develops and prevent it from healing. This is due to the spikes which are often at the heel of the shoe which will lead to greater pressure through the big toe via an increased plantarflexor force. Another common characteristic with spiked shoes is they will be pointier at the top of the shoe or toe box which can push the big toe inward towards the other toes. This is one of the reasons why hallux limitus and rigidus are common ailments in fashion among women who wear high heels or other footwear which pushes the big toe in. Switching to a lower profile shoe without spikes should provide some immediate relief however won’t likely solve the problem unless you are in the very early stages of your big toe pain. Shoes with a wider toe back and a more rigid sole will also provide relief. Combine the switch to spike less shoes and the below recommendations under treatment to best combat your big toe pain.

Common causes

  • Excessive extension of big toe during follow through
  • The long time spent on the feet and walking can cause further aggravation to the big toe and limit it’s healing
  • Golf shoes with spikes can exacerbate big toe pain

Hallux limitus vs rigidus

Hallux limitus and rigidus are two of the more serious forms of big toe pain. Hallux limitus is characterized by a lack of mobility in the big toe as well as being painful. However you will still be able to walk and perform your daily duties and will also be able to play some golf albeit with pain that will affect your ability to play. You will also lack the necessary mobility and extension of your big toe during the follow through which will severely decrease your power output with a large loss of yardage likely. Hallux rigidus is the more serious form which can occur if limitus is left untreated. With Hallux rigidus you will have limited or no mobility at all in your big toe. The big toe will be very painful and your ability to walk will be severely limited or impossible. You will not be able to play golf with Hallux rigidus or if by some miracle you are able to swing a club, you will be so limited due to the lack of mobility and push-off that you mine as well not even try.

Hallux Limitus

  • Big toe is limited in movement and unable to bend fully
  • Painful big toe during walking which is exacerbated when pushing off the forefoot such as going up stairs or during follow through of golf swing
  • Typically inflamed, sore, and stiff
  • Can be treated with conservative measures

Hallux rigidus

  • Big toe will be rigid with very little or no mobility at all
  • Very painful
  • Walking and normal mobility will be very restricted if not impossible
  • Will typically require surgical intervention

How it will affect your golf game

1. Lack of enjoyment

Angry golfer

Playing golf with any type of pain is not fun whether it is in your shoulder, back, or your big toe. The first and most obvious way that having big toe pain will affect your golf game is that you won’t be having as much fun. Especially if you are a competitive golfer and are unable to use a golf cart. This means that you will be forced to walk possibly over 45,000 steps over the course of a tournament. Being competitive in golf is hard enough as it is let alone having debilitating pain to go along with it.

2. Difficulty concentrating

If during every swing you are anticipating having pain through the follow through this will affect your ability to concentrate. Golf is just as much a mental game as it is a physical one. The last thing you want is to have anything else that could affect your ability to concentrate. You already have to take into account wind, moisture in the air, slope to your target, firmness of the green, etc… Add a painful swing to the mix and that could be enough to knock you off your game.

3. Lack of power=Less yards

During the downswing into the follow-through the back foot acts as a power generator. One thing in common with the big hitters on tour and especially long drive competitors is they will almost “jump” off the back foot during the follow through. Watch Kyle Berkshire below who is the 2021 long drive champion and pay close attention to his right “back” foot on the down swing into follow through. You will see how much pressure he puts through his right foot as it looks as if he is almost jumping off the foot. That provides a significant amount of power generation which in turn leads to faster club head speed and ultimately more yards off the tee. If you have big toe pain you simply will not be able to put much pressure on it which takes away a key power generator during the swing which will lead to a drastic drop in yardage off the toe. I would not be surprised if your average drive is 240 that you would struggle to get 200 off the tee if you have big toe arthritis. With hallux limitus I would be surprised if you could eek out 180. And forget about it with hallux rigidus as you likely won’t be able to get out of the golf cart.

4. Compensations

A common theme with pain is people will do anything they can to avoid it. Unfortunately with the human body this can lead to kicking the can down the road and adding even more problems. With big toe pain you will lack the necessary push-off during the down swing into follow through to hit the ball far enough. To compensate you might try and rotate the upper body or lower body or possibly both more. If you are young and limber this might not be a problem. However if you are older with some mobility issues this can be a disaster. What started off as just arthritis in your big toe could quickly turn into degeneration of the shoulder or hip joint and subsequently a hip or shoulder replacement will be needed down the line. My advice would be to take care of the big toe problem as quickly as possible so you don’t turn a small problem into a big one.

Treatment

1. Rest, ice, and elevation

The first and easiest thing you can do is to take a break from golf to allow the inflammation to subside. This is particularly effective if you are in the beginning phases of having big toe pain. If you are also active away from the golf course you will need to tone down those activities as well especially if they involve extension of the big toe such as with running or other sports. Ice is also very effective in the early stages of big toe pain here as it will decrease the swelling and inflammation in addition to providing some pain relief. Apply an ice pack for 15 minutes three times per day for 1 week and then decrease to 1 to 2 times per day. Elevating the affected side will also allow some of the swelling to go down. You can kill two birds with one stone by icing the big toe and elevating at the same time by lying down flat in bed or the couch with the leg stacked on top of two or three pillows so that your foot is clearly above the level of your heart for the 15 minutes it takes to ice the toe.

2. Gentle stretches

Gentles stretches for the big toe can be an effective method to improve mobility to the joint, provide increased blood flow to the area which will flood the area with nutrients to allow it to heal, and provide some pain relief. These stretches are very light and easy to perform on your own. Below is are two excellent videos describing several self mobilization techniques in the first video and an excellent overview in the second video on hallux limitus and rigidus as well as some stretches.

3. Orthotic

For some individuals you may be genetically predisposed to getting big toe pain simply due to the anatomy of your feet. While there are some things you can do to decrease the likelihood of big toe pain such as wearing proper fitting golf shoes without spikes and maintaining good mobilization and ROM of your foot joints the fact is you can still develop big toe pain through no fault of your own just due to your genetics. Your anatomy may also be fine but through repetitive wear and tear or faulty mechanics during your golf swing you have caused enough damage to your ligaments and joint that a custom orthotic is now necessary. A foot orthotic prescribed by a knowledgeable podiatrist can offset the pressure applied to the big toe and disperse that pressure to the rest of the foot so you do not have as much pain or discomfort.

4. Surgery

Unfortunately not all conservative methods such as described above will be effective enough to decrease your pain. If conventional methods have not worked and you have seen a Physical Therapist or other medical provider and have not found any relief, your Doctor may recommend surgery. There are many different methods that can be used here depending on the foot surgeon you end up seeing. It may be as simple as removing a bone spur or bone build-up which will provide enough relief to get you back on the course. A more serious surgery which is often a last resort is a fusion at the big toe joint which will then leave you with no mobility in that joint and subsequently no push-off when walking or during the golf swing. I would recommend you try and schedule any surgery in the offseason so you are not tempted to rush out and play a round before you are fully healed following surgery. This is even easier for those of you who have a winter season as you will likely be less active anyways during that time which allows for a perfect recovery time.

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Ellen
Ellen
2 years ago

Very informative article by Dr.Rob.

Carl
Carl
2 years ago

This is what I have . Thanks for the remedies.

Disclaimer

Although I am a Doctor of Physical Therapy by profession, I am not your Physical Therapist nor am I a Medical Doctor. All content and information on this website are for informational purposes only, do not constitute medical advice, and do not establish any kind of patient-client relationship by your use of this website. A patient-client relationship with you is only formed after we have expressly entered into a written agreement with you that you have signed including our terms to represent you in a specific manner. Although we strive to provide accurate general information, the information presented here is not a substitute for any kind of professional advice, and you should not rely solely on this information. Always consult a professional in the area for your particular needs and circumstances prior to making any professional, legal, medical and financial, or tax-related decisions.

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2 Comments
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Ellen
Ellen
2 years ago

Very informative article by Dr.Rob.

Carl
Carl
2 years ago

This is what I have . Thanks for the remedies.

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