While your big toe (also known as your great toe) may take up the most real estate, your second toe can cause significant amounts of pain if you’ve an injury or chronic condition.

Second toe pain can lead to aching and discomfort that makes every step more uncomfortable than the one before. This article covers the causes of pain that are specific to the second toe or that may radiate to the second toe.

Capsulitis is a condition that causes irritation and inflammation of the ligament capsule at the base of the second toe. While you can have capsulitis in any toe, the second toe is most commonly affected.

Symptoms associated with second toe capsulitis (also called predislocation syndrome) include:

  • pain at the ball of the foot
  • pain that worsens when walking barefoot
  • swelling in the toes, particularly at the base of the second toe
  • trouble putting on or wearing shoes

Sometimes, a person with second toe capsulitis will report they feel like they’re walking with a marble inside their shoe or that their sock is bunched underneath their foot.

The most common cause of capsulitis is improper foot mechanics, where the ball of the foot may have to support excessive pressure. Additional causes may include:

  • bunion that leads to deformity
  • second toe that’s longer than a big toe
  • tight calf muscles
  • unstable arch

Metatarsalgia is a condition that causes pain in the ball of the foot. The pain can concentrate under the second toe.

Typically, metatarsalgia begins as a callus on the bottom of the foot. The callus can put pressure on nerves and other structures around the second toe.

The most common cause of metatarsalgia is wearing shoes that don’t fit well. Too-tight shoes can cause friction that builds a callus while loose shoes can also rub a callus.

When a toenail is embedded into the toe’s skin on one or both sides, you can get an ingrown toenail. Symptoms include a toe that feels hard to the touch as well as sore and tender. Injury, cutting toenails too short, or wearing shoes too tight can all cause an ingrown toenail.

Also known as Morton’s foot, Morton’s toe occurs when a person’s second toe is longer than the first. Sometimes, a person can experience symptoms related to the difference in toe length, including second toe pain, bunions, and hammertoes. They may also have problems in finding a shoe that fits well.

A person with Morton’s toe also may adjust their walk by shifting their weight to the ball of their foot at the base of their second through fifth toes instead of the base of the big toe. This can cause discomfort and even musculoskeletal problems if not corrected.

Morton’s neuroma is a condition that usually develops between the third and fourth toes, but can cause pain in other toes as well. The condition occurs when a person develops a thickening of tissues around the nerve that leads to the toes. A person can’t feel this thickening, but can feel the symptoms it causes, including:

  • burning pain in the ball of the foot that usually extends to the toes
  • numbness in the toes
  • pain in the toes that worsens when wearing shoes, especially high heels

Morton’s neuroma is usually the result of excess pressure, irritation, or injury to the ligament or bones of the toes and foot.

Freiberg’s disease (also known as avascular necrosis of the 2nd metatarsal) is a condition that affects the second metatarsophalangeal (MTP) joint.

Doctors don’t fully understand why this occurs, but the condition causes the joint to collapse due to lost blood supply to the second toe. Symptoms of Freiberg disease include:

  • feeling of walking on something hard
  • pain with weight-bearing
  • stiffness
  • swelling around the toe

Sometimes, a person with Freiberg’s disease will have a callus underneath the second or third toes as well.

Conditions that can plague the toes and feet can also cause second toe pain. These don’t always affect the second toe, but have the potential to do so. Examples of these conditions include:

Talk to a doctor if you think any of these conditions could be causing your second toe pain.

Treating toe pain as early as possible is usually the key in ensuring pain doesn’t get worse. Using the principles of rest, ice, and elevation can often help. Other treatment options include:

Sometimes surgery is needed to correct damage to the toes. For example, if a person has capsulitis and the toe has started to redirect toward the big toe, only surgery can correct the deformity. The same is true for bony prominences, such as bunions.

Those with Freiberg’s disease may require surgical removal of the metatarsal head.

Any time pain restricts your movement or daily activities, you should see a doctor. Other symptoms that warrant a visit to your doctor include:

  • inability to put your shoe on
  • swelling

If your toe starts to become discolored — especially blue or very pale — seek immediate medical attention. This could indicate your second toe isn’t getting enough blood flow.

Second toe pain can be the result of different causes. The pain usually isn’t cause for emergency and can be treated at home.

However, if your symptoms indicate that you’re not getting enough blood flow to your toe (such as your toe turning blue or very pale), seek immediate medical attention.