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A numb big toe can be problematic and compromise one’s activities.  What is a numb big toe?  What are the causes of a numb big toe?  How do you treat a numb big toe?  Is a numb big toe a sign of diabetes?  Let’s dig in.

Numb Big Toe

This is when the big toe has diminished or absent feeling and is oftentimes is associated with tingling.  Big toe numbness is oftentimes dismissed as nothing more than a nuisance but may actually be a warning sign that something more significant is going on. You should be especially concerned if it’s happening often with certain activities.

Causes of a Numb Big Toe

Direct Compression

A shoe or boot that is too small or laced too tight may cause numbness.

Big Toe Arthritis

Swelling, bunions and bone spurs in the big toe may cause nerve compression and big toe numbness (1).

Peripheral Nerve Injury

Peripheral neuropathy is a condition where the nerves that transmit the electrical signal from the spine to the rest of the body become damaged or diseased.  This nerve injury can result in numbness or weakness in the upper and lower extremities.  There are many causes of peripheral nerve injury which include diabetes, poor circulation, auto-immune diseases, chemotherapy, poor nutrition, trauma, and alcoholism (2).

Nerve Entrapment

As nerves exit out of the spine, they branch into the hip, posterior thigh, knee and ankle, and toes. Nerves can become compressed as they twist through narrow areas in the lower extremity.   Examples include the common peroneal nerve as it winds around the knee bones and the tibial nerve as it descends across the ankle. These are examples of common peripheral entrapments that can result in numbness and weakness (3).


Low Back Injury with L5 Nerve Irritation

In the low back, there are 5 lumbar bones called vertebrae.  At each level a nerve exits through a boney doorway termed foramen.  Foramen means opening.   The L 5 spinal nerve exits the spine and branches down through the hip, thigh, lower leg and into the foot and big toe.  It is responsible for both the strength and feeling in the lower extremity including the big toe. The L5 nerve is specifically responsible for the feeling in the big toe whereas the S1 nerve is responsible for the feeling in the other toes   An irritated or pinched L5 nerve can cause pain, numbness or tingling in the big toe.  Surprisingly, many patients do not have low back pain despite a pinched or irritated spinal nerve and accompanying big toe numbness.  Big toe numbness may simply be the body’s early warning sign that there is a danger ahead if we don’t intervene now.

So what can cause irritation or compression of the L5 spinal nerve and resultant big toe numbness?  There are many causes which include lumbar disc herniations or bulges, arthritis in the spinal joints and narrowing of the central canal or the boney doorway through which the spinal nerve exits (4).


To better understand the significance of big toe numbness please click on the video below.


How Do You Treat a Numb Big Toe?

Treatment depends upon the cause of the numbness.  If conservative measures such as rest, change in footwear and physical therapy fail to improve the numbness a deeper look is required. If you have diabetes, poor circulation, an autoimmune disorder or family history of such, an examination by your local physician is necessary.  If big toe numbness is episodic and associated with specific activities such as running, lifting and jumping, it is time to be evaluated by an interventional orthopedic physician.  It is important to determine the cause of big toe numbness before it progresses and causes more serious and lasting injuries. At the Centeno Schultz Clinic, we have extensive experience in the treatment of low back injuries that cause lower extremity and toe numbness.  Treatment options include PRP and bone marrow-derived stem cell injections.

To learn more about what Interventional Orthopedics is, click on the video below.


In Conclusion…

Big toe numbness can be caused by many factors which include tight shoes, toe arthritis, damage to peripheral nerves, nerve entrapment and low back injuries.  A thorough evaluation is important if you have a significant past medical history including diabetes, and or, poor circulation.  If your numb big toe comes and goes, and is associated with impact activities such as lifting and running, a back injury with nerve irritation may be responsible.  Early evaluation and treatment is best before additional injuries occur.



1. PALLIS CA, SCOTT JT. PERIPHERAL NEUROPATHY IN RHEUMATOID ARTHRITIS. Br Med J. 1965;1(5443):1141. doi: 10.1136/bmj.1.5443.1141

2.McLeod JG. Investigation of peripheral neuropathy. J Neurol Neurosurg Psychiatry. 1995;58(3):274-83. doi: 10.1136/jnnp.58.3.274

3.Poage C, Roth C, Scott B. Peroneal Nerve Palsy: Evaluation and Management. J Am Acad Orthop Surg. 2016;24(1):1-10.DOI: 10.5435/JAAOS-D-14-00420

4.Kreiner DS, Hwang SW, Easa JE, et al. An evidence-based clinical guideline for the diagnosis and treatment of lumbar disc herniation with radiculopathy. Spine J. 2014;14(1):180-9.DOI: 10.1016/j.spinee.2013.08.003


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