Big toe numbness – while it might not be particularly common, or even that concerning—it’s just a toe after all— when your big toe goes numb, it can certainly get your attention. And for good reason; it’s usually an early warning sign that something more significant is going on.
You should be especially concerned if it’s happening often or in on-again-off-again episodes and with certain activities. The good news is, addressing it when you first start to notice it may save you from more advanced damage in the future.
Numbness in toes can be caused by circulation problems or a nerve issue in the toe itself, but more often than not, the low back is the culprit. This is especially the case if it’s not just numb but there is pain and numbness in the big toe. Let’s look at the link between the low back and big toe.
Big Toe Numbness and Your Low Back
Believe it or not, one of those significant issues that can present as numbness stems from the low back. In the lumbar spine, the nerve that exits the spine at the L5 level branches down through the hip, thigh, knee, lower leg, and, yes, all the way into the foot and toes. So a pinched or irritated nerve at that L5 level in the back can create problems, such as pain, numbness, tingling, and so on, anywhere along the nerve branch.
So what can irritate the L5 spinal nerve? The list is long, but it includes disc issues, such as herniated or bulging discs; arthritis in the spinal joints (inflammation can put pressure on the nerves); back injuries; foraminal stenosis, which is when the channels that the nerves run through narrow (and can be caused from any of the above); and so on.
Interestingly, your back may not even hurt if you have a pinched or irritated spinal nerve. The body works in fascinating ways, and big toe numbness may be the body’s way of throwing up an early warning flag to let us know there’s danger up ahead if we don’t intervene now. Numbness today may be big toe pain and stiffness tomorrow. Next thing you know you’ve developed bunions (bone spurs), you have knee pain (maybe even progressing arthritis) due to stability issues, and more damage is being done to the spine you never had checked, which keeps the damage cycle in motion.
Learn more by watching the brief video below:
While low back issues are a common instigator of a numb toe, there are other issues that could be at play.
Other Causes of a Numb Big Toe
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 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 .
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.
Degenerative Scoliosis, also known as Adult-onset Scoliosis, is a medical condition that involves a side bending in the spine. The bending can be mild, moderate, or severe with side-bending to either the right or the left. The term degenerative means generalized wear and tear and is common as we get older. Degenerative scoliosis is the curvature of the spine that occurs as a result of degeneration of the discs, small joints, and building blocks. The Degenerative Scoliosis curve is often located in the low back and forms a ‘C” shape. There is a convex and a concave side. The convex side is the open side where it curves outward.
Disorders that affect and weaken the connective tissues such as tendons and ligaments. It is a hereditary disorder which means you are born with it. EDS has many different signs and symptoms which can vary significantly depending upon the type of EDS and its severity. It most commonly affects the skin, joints, and blood vessels. Joints are typically hypermobile with excessive joint range of motion because of a defect in collagen formation. In most cases Ehlers-Danlos syndrome is inherited. That is to say that you are born with it. The two main ways EDS is inherited are: autosomal dominant inheritance and autosomal recessive inheritance…
Failed Back Surgery Syndrome also called failed back is a clinical condition in which patients who have undergone low back surgery continue to have pain and dysfunction. Said another way the surgery that was intended to reduce pain and increase function FAILED. That is right, the surgery failed. You had the surgery, struggled with the pain postoperatively, diligently participated in physical therapy and yet the pain and limitation are still there. Unfortunately, this occurs frequently. Estimates range from 20-40% of patients who undergo low back surgery will develop Failed Back Surgery Syndrome. Pain is the most common symptom of Failed Back Surgery Syndrome…
A herniated thoracic disc is especially difficult because there aren’t as many treatments available as there are for disc herniations in other areas of the spine. To understand Thoracic Disc Herniations, though, we first need to cover thoracic spine anatomy and function. With disc herniation, the annulus fibrosus get small tears throughout the annulus. An annulus is a bunch of concentric fibers, so, as the fibers get damaged and cut, the pressure that is built up within the nucleus pushes the now weakened annulus outward, creating a bulge or herniation. The disc begins to weaken via mild degeneration/tearing of the annular fibers…
We talk a lot about leg pain stemming from a pinched or irritated nerve in the lower back. And, indeed, that’s what our physicians are traditionally taught in medical school—a pinched nerve in the lumbar spine typically presents as a symptom in the leg. However, what if you have some butt pain but no pain or other symptoms in the leg? Does this mean it couldn’t be a pinched nerve? Not so fast. Turns out a pinched low back nerve doesn’t always have to be accompanied by leg symptoms.
Let’s start by taking a look at how the back is structured.
Disc herniation, disc protrusion, overgrowth of the facet joint, and thickening of the ligaments can result in nerve root compression or irritation, causing symptoms of sciatic compression. Some causes of sciatic compression can be interrelated with the following conditions: Degenerative disc disease, Spinal stenosis, damage or injuries to the discs, spondylolisthesis, piriformis syndrome, osteoarthritis. The symptoms of sciatica include pain in the lower back, buttock, and down your leg, numbness and weakness in low back, buttock, leg, and/or feet, pain increase with movement, “Pins and needles” feeling in your legs, toes, or feet., loss of bowel control, and incontinence. Sciatica can be treated…
The sacroiliac joints reside between the sacrum (the tailbone segment of the spinal column) and the prominent wing-like iliac bones that form the pelvic girdle. There are two SI joints, one on the left and one on the right (highlighted in red in the image above), and along with the symphysis pubis joint at the front of the structure, they are critical for transferring forces and energy back and forth between the spine and the lower limbs. There are a number of reasons that an SI joint can become painful and inflamed, leading to SI joint syndrome. Trauma, such as a fall injury to the tail bone or a forced injury from a car accident for example, obviously can create problems in the SI joint…
Spinal stenosis is the narrowing of the central spinal canal and is a cause of significant pain and disability. Common causes of spinal stenosis include disc protrusion, facet overgrowth and ligamentum flavum thickening. Surgery is often chosen when conservative therapies fail despite the lack of convincing evidence that it is a superior treatment option. Are there alternatives to back surgery for spinal stenosis? Yes. Regenexx DDD utilizes precise platelet injections into the facets, muscles, and ligaments to treat the lumbar stenosis, treating all of the components of the issue, which is crucial. Spinal stenosis is often an age-related condition attributed…
Spondylolisthesis means that one vertebra is slipping forward or backwards on another. This causes the hole where the nerve exits (foramen) to get smaller (also called foraminal stenosis). It also causes more wear and tear on the facet joint which can lead to arthritis or what’s called “facet hypertrophy”.
The amount of slippage is graded 1-4, with grade 1 meaning that the one vertebra has slipped up to 25% on the other vertebra. Grade 2 means that one bone has slipped from 25-50% with higher grades indicating more slippage. The vast majority of patients are grade 1 to 2.
Arthritis in the big toe is less likely to cause numbness and more likely to make the toe stiff or painful. Bunions themselves, which are often caused by a low back issue, can put pressure on surrounding structures and create big toe numbness in the process. Tendon injuries should also be considered when tracing the source of the numbness, especially when other symptoms are also present, such as alternating pain and numbness.
With arthritis of the big toe, a big toe fusion, which involves fusing two or more toe bones together to make them immovable or removing and replacing the big toe join, is often the surgical solution. These invasive major surgeries result in lengthy recovery times and can create more problems than they solve.
The flexor hallucis longus tendon can also become injured. This tendon stretches along the underside of the big toe, and damage to it can cause stiffness in the toe. You may also experience symptoms as far up as your ankle. If your numbness has progressed to pain and even debilitation, this tendon needs to be considered.
When Conservative Measures Fail
If conservative measures, such as rest and physical therapy, are unable to address your big toe numbness, it’s time to have your toe examined by an interventional orthopedic physician who can determine the source. Whether it’s the lower back, the big toe itself, or both, an injection of platelet growth factors may be all you need to address the problem.
In order to address your problem, it’s important that you don’t delay examination. It’s best find the source and treat it quickly before that early warning signal becomes a full-on train wreck. Surgery is typically a much less than ideal solution, so it’s a good idea to seek nonsurgical regenerative medicine solutions first, like at our clinic, Centeno-Schultz Clinic.
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.
Geletka BJ, O’Hearn MA, Courtney CA. Quantitative sensory testing changes in the successful management of chronic low back pain. J Man Manip Ther. 2012 Feb;20(1):16-22. doi: 10.1179/2042618611Y.0000000014. PMID: 23372390; PMCID: PMC3267442.