# Turf Toe (or big toe joint pain) from biking?



## jtuds (Jun 14, 2016)

Hi folks...

For those of you unaware of the term "turf toe", it is caused by the repeated, and often forceful upward bending of the big toe. This causes the collateral ligaments on either side of of the big toe and possibly the flexor hallicus brevis ligament to become aggravated and potentially damaged. There are two small bones under the big toe called sesamoids and they can get pushed out of place, causing people to put pressure on them while moving, and causing aggravation to the ligament.

I am wondering if anyone here has ever had the same issue I am having or if anyone might be able to help me sort out the cause.

My left big toe has been painful for the last week or so and it has kept me off the bike. I just bought my first road bike and cycling shoes. Previous to that I had been on a mountain bike and always had normal pedals with athletic shoes.

I used to play football and was a receiver and defensive back, so a lot of starting and stopping, changing direction, etc. Back in those days (about 10 years ago now, until I was 23) I would sometimes get really bad big toe pain after practice. I'd have to wear sandals and it would cause me to limp, then would go away and I'd do it all over again.

Over the last decade it has flared up a couple times. I actually thought I had gout and had blood taken but it wasn't gout. I also had the foot x-rayed and the doctor said there was nothing of concern. Now here I am with really bad pain in the left big toe.

I am wondering if the rigidity of the cycling shoes and placement of the cleat on the shoe might be contributing to the problem. Also, could the shoes be too small? My big toe on my left foot almost touches the end of the shoe but the right one fits great.

Anyway, I am sort of venting here because it is very frustrating and discouraging....has anyone dealt with or heard of anything like this?

Thanks.


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## RRRoubaix (Aug 27, 2008)

Absolutely!
The harder the ride, the more likely the main joint in my big toe hurts, usually the left foot. (Is that "turf toe"? Unsure, but sounds like it). Hurts to walk the next day or so.
My sports-physio/chiropractor had me cut out a relief in my insoles, just under that joint. It has helped quite a bit, but there are still plenty of times it happens.


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## jtuds (Jun 14, 2016)

RRRoubaix said:


> Absolutely!
> The harder the ride, the more likely the main joint in my big toe hurts, usually the left foot. (Is that "turf toe"? Unsure, but sounds like it). Hurts to walk the next day or so.
> My sports-physio/chiropractor had me cut out a relief in my insoles, just under that joint. It has helped quite a bit, but there are still plenty of times it happens.


It really, really sucks and really, really hurts. I am sitting here right now with by foot in a bucket of ice. All I did today was walk about 8 blocks in running shoes and ride my bike around the block twice.


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## desaljs (Jun 5, 2015)

You have me interested with this post. I am not a foot specialist, but see a lot of patients with muscle/tendon/ligament problems. My first thought, knowing what I know about "turf toe" would be the toe box in your shoes is too tight. Traditionally, turf toe would be due to direct trauma and/or hyperextension of the great toe. Cycling shoes are designed with stiff soles, so I do not think hyperextension is the issue. It could be a compression problem. I ride a "mountain bike" set-up on my road bike, with Shimano SPD pedals, and mountain bike shoes (recessed cleat so I can walk). These shoes have more room in the toe box. Look into this as an option if you cannot get this sorted out.


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## jtuds (Jun 14, 2016)

I do think my left shoe might be too tight....

I have never really had a direct trauma that I can think of....but the turf toe I got from football I think came from my big toe constantly hitting the end of my shoe and forcefully bending upwards which causes the hyperextension/aggravation. So I was thinking maybe a too-tight cycling shoe, in which my toe hits the end while I pedal, could have caused the current issue by similarly forcing hyperextension of the big toe...albeit less forcefully than playing football but more repeated.

I am trying to blitz it with NSAIDs and ice today so I can ride this weekend...this is a long weekend in Canada and I don't want to be laid up the whole time...


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## fronesis (Jan 22, 2014)

jtuds said:


> I do think my left show might be too tight....
> 
> I have never really had a direct trauma that I can think of....but the turf toe I got from football I think came from my big toe constantly hitting the end of my shoe and forcefully bending upwards which causes the hyperextension/aggravation. So I was thinking maybe a too-tight cycling shoe, in which my toe hits the end while I pedal, could have caused the current issue.
> 
> I am trying to blitz it with NSAIDs and ice today so I can ride this weekend...this is a long weekend in Canada and I don't want to be laid up the whole time...


1. Definitely make sure you have the right size shoes.

2. Consider going to a shoe with a wider toebox. My feet are really wide in the toe area, and I found moving to Lake shoes made a huge difference.

3. Make sure your cleats are aligned properly.


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## jtuds (Jun 14, 2016)

fronesis said:


> 3. Make sure your cleats are aligned properly.



Right now they are totally centred front to back and side to side. I have thought about moving them, but am unsure in which direction they would need to be moved. While riding, my knee/foot alignment at the 3 and 9 pedal positions are pretty ideal so I am worried that if I move the cleat and throw off that alignment, I could cause another issue.


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## fronesis (Jan 22, 2014)

jtuds said:


> Right now they are totally centred front to back and side to side. I have thought about moving them, but am unsure in which direction they would need to be moved. While riding, my knee/foot alignment at the 3 and 9 pedal positions are pretty ideal so I am worried that if I move the cleat and throw off that alignment, I could cause another issue.


It's a tricky process and there is no singular solution.

If you haven't read Steve Hogg's stuff on cleat positioning, it might be worth a read. In my case, he convinced me that I wanted my pedals a bit further back than "standard" fitting approaches suggest, and it's worked well for me. 

Foot pain (of many varieties) can also be connected to shoe sole type and cleat type. I was having lots of hotspot troubles and solved some problems by switching from speedplay to SPD-SL. Of course, lots of other folks have had great success with speedplays, so I'm not recommending one over the other, just saying that if your problems recur, you could consider trying various combinations to feel what's right.

But my first instinct with respect to your problem is to try a shoe with a wider toebox.


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## jtuds (Jun 14, 2016)

I am still within the 30 day return period for the Bontrager shoes I bought, so I am likely going to be using it to try and find a pair that will do what I need.


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## MaxKatt (May 30, 2015)

Sidi shoes come in a "mega" size which has a bigger toe box.


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## PBL450 (Apr 12, 2014)

The permanent but expensive solution would be customs shoes. Go to a Podiatrist and rule out structural causes and the like, and get their opinion. If you have a strange foot, like I do, a custom shoe will fix the issue. Bont shoes are hard sided and fully heat moldable. They can do custom for the big money, in which case you can go back to the Podiatrist to get molded and mail them the molds. The shoe will literally be exactly your foot. Semi-custom is a good option, it's a $30.00 upcharge. You can trace your feet and send them to a rep, I work with a very good one, and they can tell you what you need. A semi-custom wide will be moldable to fit odd shape feet, but it has to be the right size to begin with. Bont will let you order different size shoes right/left too... If you look at a Bont shoe you will see the lasts are shaped differently than everyone else. Wider toe, more like a foot. Happy to send more info if you want. In a custom Bont there will be zero odd toe movement. Good luck, this is a sucky problem...


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## jtuds (Jun 14, 2016)

Thank you...I'll look into it. It's a miserable predicament and seems to have hit me ought of nowhere. Here I am eager to get riding more, and my wife is on board and ready to go as well, then this.


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## Migen21 (Oct 28, 2014)

I developed this in a pair of Sidi Mega's. I also developed a blister on my big toe which ended up turning into an Ulcer.

This happened during the offseason when I was doing a LOT of trainer riding (rehab for a shoulder injury), and did a marathon sufferfest session for a charity event. 

It turns out the problem was caused by a combination of a steep arch support (i have high arches and a huge instep), and a significant upward curve of the toe of the shoe. This combination was causing my toe to bend up/back at a fairly severe angle. It wasn't painful (until the blood blister formed), but the next day my toes on both feet were very sore. I ended up having to go to a podiatrist (I took the shoes - he helped me find the issue).

I solved the problem by downsizing my arch support a bit, and putting a partial insole under the ball of my foot. I also found a shoe that had a little less upward curve in the toe (Pearl Izumi Road III and Road IV in this case). 

Not necessarily related to the toe problem, but after a detailed fit, I found that I needed a bit of wedge in both shoes. Two of the "Orange" Varus Wedges under my insoles (both shoes). I also switched insoles to use the Shimano Moldable Footbed (you put them in an oven and heat them up, then stick them in your shoes to form to your feet). 

The combination of shoes, wedges, and insoles are soooo comfortable. If they didn't have huge cleats on the bottom I'd wear them everywhere (except maybe to bed). =)


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## PBL450 (Apr 12, 2014)

Migen21 said:


> The combination of shoes, wedges, and insoles are soooo comfortable. If they didn't have huge cleats on the bottom I'd wear them everywhere (except maybe to bed). =)


That's how I feel about my full custom speed skating shoes. Most comfortable thing I ever owned, the footed is perfection... And they are all carbon fiber except for the tongue with less than 1mm of padding.


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## jtuds (Jun 14, 2016)

It's been about a month now and the toe pain is pretty much gone. It got really, really bad.

I still have pain around the toe, and i do think that is from cycling and playing squash. They're feet...wtf am I supposed to do? I can't stop all my activity. But it is nowhere near as and as it was.

I now think it was gout. It happened the night I ate a pasta with shrimp and scallops in it and had 2 pints. Shellfish and beer, two of the worst triggers for gout. it happened a night - a gout symptom. The location was the same place as gout targets.

On the flip side, the doctor sent me for blood work and the gout-related measures came back within the normal range and way below the danger zone. I'm also way younger than a person who gets gout should be.

Nonetheless, there are younger people who get it and people who get it despite being in the normal ranges on their blood work.

So I go back for more bloodwork in 3 months but lucky for me, the worst of the pain is gone....now it is back to just thermal amount of toe pain.

I know at least one thing that is worse than cutting back on red meat, seafood and beer......gout pain!


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## D&MsDad (Jul 17, 2007)

Since you're seeing a Dr., it seems you have insurance. I'd strongly suggest seeing a podiatrist, if possible one specializing in treating athletes - if you have a good LBS they may be able to give you some suggestions for a Dr. familiar with the needs of cyclists. Maybe getting a bike fitting by someone with experience with biomechanics also.

A cycling shoe with a wider toe box may help, you may need a foot bed, orthotic or a shim under your cleat to align your foot/ankle/lower leg/knee/etc. so you're not putting pressure on the joint but instead are spreading that pressure out over the whole forefoot.


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## factory feel (Nov 27, 2009)

I knew a girl who had a sore toe.


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