Big Toe Blisters: Types, Causes & Prevention

by Rebecca Rushton BSc(Pod) 1 Comment

In this article, you'll learn what causes blisters under the big toe and the two most effective ways of preventing them: ENGO blister patches and changing your biomechanics.

 

Big toe blister - edge blister
Big toe edge blister (Image credit)

 

What causes big toe blisters?

Blisters under the big toe are more than likely a consequence of your foot's structure or biomechanics. Here are some potential contributing factors:

  • You walk with your feet turned out and roll off the side of the toe rather than toeing-off straight through the toe.
  • Your big toe is angled towards the others (often the result of a bunion) and the same thing happens.
  • Your gluteal muscles are weak causing more internal leg rotation, foot pronation and pressure under the edge of the big toe.
  • You're wearing shoes that are too narrow at the toes, so a part of your big toe is "hanging over the edge" of the shoe.
  • Your big toe knuckle (1st MPJ) is stiff in the upwards direction causing higher weightbearing forces under the big toe.
  • Your big toe knuckle has plenty of upwards bend when you're off your feet. But when you're on your feet, this range of motion becomes unavailable for biomechanical reasons (more on this below). 

A common biomechanical cause of big toe blisters

An inefficient windlass mechanism

The windlass mechanism is an important biomechanical function in the foot that promotes efficient gait. When this is not working efficiently, one consequence is lower forces under the big toe knuckle and high forces under the big toe.

An inefficient windlass mechanism can cause blisters under big toe
High pressure under the big toe (not under the MPJ) due to a functional hallux limitus (inefficient windlass mechanism)
High pressure under the big toe (not under the MPJ) due to a functional hallux limitus (inefficient windlass mechanism)

 

Take a look at the pressure map above. This person had what we call a "functional hallux limitus" (FnHL). A FnHL is caused by an inefficient windlass mechanism. That means she had plenty of upwards bend at the big toe knuckle. But when she walked, this range of motion was not available. And so an excessive amount of pressure was borne by the big toe. A more normal pressure map would see red under the knuckle, not under the big toe.

 

Don't forget friction

The friction properties of all the materials within your shoe are high. I'm talking about:

  • Your clammy skin
  • Your moist socks
  • The interior lining of your shoes
  • The innersole material
  • The cover on your orthotic

    It's important that these materials are high friction. Because your foot needs traction within your shoe. You don't want your feet sliding around too much in there! Thankfully, most people get away with these high friction levels most of the time. But for some of us, this high friction when combined with high pressure, produces an amount of skin shear that causes blisters.

     

    make sure your insole is nice and cushioned, not flattened out under your big toe
    Like all innersoles and cushioned insoles, the friction level is necessarily rather high. The cushioning is great, you definitely want that. We just have to reduce the friction level where we're getting blisters. This is easy to do with ENGO patches (coming up next).

    Preventing big toe blisters

    Let's hone in on what I believe are the two most important preventive strategies for big toe blisters.

    blood blisters under the big toe
    Big toe blood blisters (image credit)
     

    1. Cutting friction levels with Engo Patches

    If changing foot function is insufficient, you’ll need to rely on reducing friction levels. If the blistering is under the toe only, one patch under the toe is all that’s needed. The patch shown on the insole is a large oval patch, from the ENGO 4-Pack.

    Place an ENGO large oval patch under your big toe for blistersENGO Patch (large Oval) placement for blisters under the big toe

     

    If you’re dealing with more of an edge blister (watch the video below to figure out if you are), use the Two-Patch Technique. In this instance, you'll need two of these oval patches per shoe. Here’s the ENGO 4-Pack. This will cover two edge blisters.

     

    ENGO Blister Patches 4-Pack

    ENGO Blister Patches 4-Pack: Learn more

     

    2. Dealing with your biomechanics

    The best way to deal with high pressure under the big toe (including edge blisters) is to see a podiatrist. They will figure out if there is a reason that can be fixed by changing your biomechanics. The blisters mentioned earlier (pressure map) were addressed successfully with orthotics. Not just any old orthotics though! Orthotics with specific design features that are known to facilitate the windlass mechanism. So load is reduced under the big toe. Podiatrists have many tools and therapies at their disposal that can improve this important biomechanical function. If you're getting recurring big toe blisters, I recommend you get your feet checked.

    And they can help guide you with shoe fit and selection. If it's more of a structural reason, it’s not quite so easy to significantly reduce pressure. In these situations, managing friction in this specific location is paramount.

     

    Orthotic Design features that facilitate the windlass mechanism to stop blisters under your big toe
    Orthotic design features that facilitate the windlass mechanism

    Why do I have blisters on my right foot big toe and not my left?

    A lot of people ask why they only get a blister (or corn or callus or ingrown toenail) on one big toe and not the other. The fact is, there are a multitude of reasons. Firstly, we a not born perfectly symmetrical, left to right. As the years go by, we get less and less symmetrical. For example, we develop a dominant side which means we function less symmetrically - we favour one foot to push off on and we kick a ball with one foot in preference over the other. Not to mention asymmetrical sports - in my case, hockey.

    Then consider the common situation where one foot is slightly bigger than the other - yet the shoes you wear are exactly the same. Then consider getting a sore hip, injuring your knee or spraining your ankle. It makes you walk in a way to compensate for that sore side. These temporary or permanent causes of asymmetry could all be reasons why you get a blister on one big toe, or pinky toe or anywhere and not on the other side. They're all reasons why there are different magnitudes or durations of blister-causing forces imparted onto the skin. 

    Should I pop a blood blister on a big toe?

    Sure, you can pop a blister under your big toe. As long as you have all the right gear to care for that blister (something sterile to lance it with, antiseptic or antibiotic, island dressing). Be sure to read this blister popping article to decide whether it's a good idea for you to pop your blister.

    But also be aware that as your weight moves from heel to toe, a lot of pressure passes onto your big toe. So be sure to reduce friction levels (Engo patch on your insole). That way, your blister will be able to heal whilst you continue to walk, run or play. 

     

    Conclusion

    A couple of ENGO Patches and a trip to your podiatrist are your best chance of stopping even the worst cases of blisters under your big toe.





    Rebecca Rushton BSc(Pod)
    Rebecca Rushton BSc(Pod)

    Author

    Podiatrist, blister prone ex-hockey player, foot blister thought-leaderauthor and educator. Can’t cook. Loves test cricket.


    1 Response

    K
    K

    September 24, 2019

    Hello, my son is away at college and sent me this picture of his injured big toe. He was wearing flip flops and when going up concrete brick steps somehow missed stepped and tore a flap of skin off his big toe. He washed it well, poured on peroxide ,then applied a antibiotic ointment and bandaid. Is this the correct treatment and how long to heal? He says it is very sore to walk on. Size 16 foot.
    IMG_4039.PNG

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