Sand Toe Pain and Treatment

Sand Toe Pain and Treatment


Sand Toe is a term used to describe a sprain of the big toe when it is forced into plantar flexion.  Big toe injuries can be exceptionally painful and limiting; imagine if every step caused sharp, stabbing pain in the big toe.  If walking is painful, you can imagine how much it would hurt to run, quickly change directions, jump, or push off.


The big toe joint is more correctly called the first metatarsal phalangeal joint. The metatarsal bone meets the proximal phalangeal bone. A well-developed capsule of ligaments surround the bones. Multiple muscles either attach or cross the first metatarsal phalangeal joint. Several small bones are located in the tendons of the flexor hallucis longus (big toe flexor muscle) and are commonly confused with sand toe injuries. Likewise, injuries to both the sesamoid bones and first metatarsal phalangeal joint can occur together with trauma or certain sports injuries.


Big Toe -1st MTP Sand toe sprain

The big toe supports our body weight while walking to toe off. Hyperflexion injuries damages the joint capsule

Injuries to the big toe are common with sports and activities played on hard or uneven surfaces. Turf toe is a sports term for a hyperextension injury of the first toe. During forced dorsiflexion, the capsule of the first metatarsal phalangeal joint is stretched and strained. This can happen with either acute or chronic dorsiflexion with trips, falls, shoes that are too flexible, or being tackled awkwardly. Turf toe has become more common with the popularity of artificial turf and the use of very flexible shoes to increase agility at the expense of structural support.


Sand toe involves the opposite motion of the big toe. With either acute or chronic forced hyperflexion the top (dorsal) of the joint capsule is damaged. The toes are rolled under the foot during the injury, spraining the ligamentous joint capsule.

sesamoid bones and sand toe sprains

Sesamoid bones and surrounding tendons can also be injured in severe sand toe sprains

Evaluation of Sand Toe

Your physician or healthcare provider will examine the big toe and ask several questions about your activities. For an acute injury, the description of your toes position along with the surface and part of the joint capsule in pain will provide useful information. Chronic injuries may require information on sports, recreational activities, footwear, and hobbies.

X-rays or an MRI may be utilized to further evaluate the bones, tendons, ligaments, plantar plate,  and the joint capsule. Fractures can occur in the metatarsal, phalangeal bone, or sesamoid bones. Surgical or pain management referrals are not usually needed in big toe strains. Cortisone injections are not usually indicated for mild to moderate sprains.



Home Treatment for First MTP Sprains

The first treatment at home after a big toe sprain is to ice and rest the injured joint. Avoid activity that increases stress and strain to the toe, especially walking and pushing off with the big toe. Ice helps to decrease pain and inflammation around the injury. Ice for 15-20 minutes, then remove the ice for 15 minutes. Repeat this process several times a day to decrease inflammation.  Elevating your foot also allows the swelling to drain away from the big toe, which will help decrease overall pain and recovery times. Over the counter anti-inflammatory medications such as ibuprofen often provide symptom relief and are commonly recommended.


The big toe can be taped to the second toe to provide support and reduce the strain placed upon it with walking. Athletic, Rock Tape, or Kinesio tape can be used at home. This will help many sand toe sprains by allowing the tissue to heal instead of being reaggravated daily. More severe sprains may require a solid brace or boot to protect the first metatarsal phalangeal joint.

ice the big toe for pain after activity

Ice is great after a long run, or for chronic sand toe pain.


Conservative Treatments in the Clinic

Chiropractic or physical therapy clinics can provide treatments to decrease joint pain and inflammation, in addition to speeding cellular repair and healing. Electric therapy is a form of physiotherapy many patients are familiar with, however it is difficult to perform around the big toe. Ultrasound therapy effectively decreases pain and inflammation of the joint capsule. Cold laser is another treatment to decrease joint inflammation and speed healing. Low level lasers can enhance fibroblast activity and other structural cell building processes to shorten the overall recovery time by stimulating the repair cells with specific wavelengths of light.


Specific exercises and stretches can be given to strengthen the big toe and foot to reduce future sand toe sprains. Early joint movement and mobilization is important for the recovery process.  Orthotics may be considered with chronic cases, especially if bunions or other foot structural changes affect normal foot mechanics.


sand toe treatment with cold lasers

Cold laser for decreasing pain and inflammation for sand toe treatment.

With chronic toe, foot, and ankle injuries often scar tissue, poor neuromuscular control, and foot arch muscle weakness develop. Your provider may utilize Graston Technique, massage therapy, or Active Release Technique to address soft tissue adhesions or injuries in the foot and ankle muscles. Improving foot and ankle function reduces the likelihood of future sprains and strains.


Proprioceptive or neuromuscular training exercises engage the intrinsic muscles of the foot, and help control the arch during walking or running. Foot overpronation during walking and running changes the joint mechanics and function, increasing risk of certain injuries.  Specific exercises can be performed at home to strengthen the foot muscle and reduce injury risk.



Recovery Expectations

Mild to moderate sprains (grade I and grade II)  may require a few weeks of rest and recovery.  Severe sprains (grade III) may require more than a month off from activity. Individuals may feel sudden, sharp twinges or stabs of pain under the toe for several months. Over time the frequency and intensity of sharp pains decrease.


Severe sprains are more likely to occur with tears of the plantar ligaments, sesamoid fractures, damage to joint cartilage, or free floating bony chips in the joint. Most mild to moderate sprains resolve without future risks or complications. Care should be taken with severe sprains to reduce the likelihood of future sand toe or turf toe sprains. Chronic injuries can result from being impatient with your recovery and returning to full activity too soon.


Sand Toe sprains can be successfully treated at home and in the office. Anyone with a big toe injury will appreciate the role this joint plays in walking, jumping, and running once the pain subsides.  More information on foot and ankle pain treatments.