Prevent Chronic Climber's Toe Pain


Climbers are used to having sore little piggies, whether it’s from jamming them into cracks or cramming them into tight, high-performance shoes. But toe pain is more serious when it doesn’t disappear after a few hours, and it happens to a lot of climbers because of the way we use and abuse our feet. Chronic stiffness and swelling in the big toe joint is an early sign of osteoarthritis that could permanently cramp your climbing style.

CAUSE

Climber's-Toe-Graphic-660Osteoarthritis occurs when the cartilage protecting bones wears away, leaving the bone ends to grind painfully against each other. In the big toe, the condition is known as hallux rigidus, or the less serious hallux limitus, and it develops at the joint where the toe connects to the foot (A). Hallux rigidus may advance to the point where it’s extremely painful to walk—let alone climb—and it can require surgery to shave the bones, install a supportive implant, or fuse the joint.

Osteoarthritis usually develops between ages 30 and 60, but it can strike even earlier. Genetics, personal anatomy, and injury history are the primary determining factors, but climbers can be especially susceptible. Dr. Yvonne Weber, a podiatrist and climber, says, “Hitting your toe against the rock [as in a lead fall] or rockfall hitting the toe can lead to osteoarthritis. Also, wearing super-tight or really flexible shoes and repeating the same move puts high torque on the joint.”

Hallux rigidus frequently leads to bone spurring, a bony growth that’s painful and may require surgical treatment. Plus, by compensating for a sore toe while climbing or walking, you may overload other parts of the foot, possibly leading to neuroma (a tumor of nerve tissue) or hammer toe (deformation where toes are permanently bent).
Pain, swelling, and decreased mobility in the joint are potential indicators of hallux rigidus. If you have a family history of osteoarthritis or have injured your big toe previously, Weber says, “Get an exam and X-ray, and you and the doctor can decide how seriously to take it.”

PREVENTION
Hallux rigidus is a progressive condition, making early detection and preventive steps essential. If you experience pain or inflammation, Weber recommends the following:

  • Wear stiffer climbing shoes to support the joint. A snug fit is good, too, to maintain stiffness. But avoid shoes that crunch the toes.
  • While belaying or chilling between routes, put on stiff-soled shoes like your approach shoes or supportive sandals (read: not flip-flops). Don’t wear minimalist approach shoes or walk off a route in your climbing shoes.
  • Get highly supportive and well-fitted sole inserts for your everyday shoes—anything to stabilize the joint day to day.
  • Try MSM (methylsulfonylmethane) and fish oil to reduce inflammation, and glucosamine to strengthen cartilage.
  • When pain flares up, avoid slabs and consider toproping versus leading or bouldering—you’ll move quicker and put less stress on the joint.
  • Don’t mask chronic pain with anti-inflammatories—this condition won’t heal on its own. See a doctor.


Comments

hi gail can you please send me a photo of the orthotics ? I'de like to get a couple too my mail is jorge.canelhas(at)binarium.pt thanks

jorge - 04/21/2014 9:11:04

Thanks, Ben, for that link. Very good article with great diagrams and xrays. I think I have pain in my big toe from shoes that are too tight - pain in the forward joint (not at the base) and it's hard to describe or elicit the pain. I think it's part bunion/part twisting of the joint as it squeezes into the toebox of my 5.10 coyotes. The pain can be blinding if i hit it just right. I think I will find some less constricting shoes and maybe look for stiffer sole as Gail (above) and the doctor in your link suggested. As popularity of this sport increases, I imagine many more will have experience foot problems T.T

allan - 03/12/2014 9:02:26

Any climbers out there who have had hammer toe surgery? My husband has very painful hammer toe, and has tried conservative treatments and is considering surgery. There are 3 types of surgery: 1 where they cut a tendon to allow the toe to flatten out, 1 where they cut off part of the enlarged joint, and 1 where they take out the joint and allow the 2 toe bones to grow into a single straight bone. All of these sound fairly scary for a guy who likes to climb hard, run, nordic and telemark ski, and bike. Can anybody say if they've had any of these surgeries and can do these types of activities aggressively with their surgically repaired toe?

Sue Schroeder - 02/24/2014 4:00:33

I suffer from osteoarthritis in both of my big toes. In fact, I had surgery to "clean up" my toes. The only way I can climb comfortably is to use carbon fiber orthotics in my climbing shoes. It makes my shoes extra stiff and takes a lot of pressure off my big toes. My (very handy) husband made plaster molds of my feet and then created the carbon fiber inserts. I highly recommend this approach if you have big toe pain due to arthritis.

Gail - 01/02/2014 7:13:32

Hey, Great article. There's a very detailed article written by a physiotherapist on the same subject here: http://bouldersuk.com/2013/08/are-your-climbing-shoes-too-tight/ If anyone would like some further reading

Ben - 11/26/2013 8:11:09

Boulder Valley Foot and Ankle https://www.facebook.com/pages/Boulder-Valley-Foot-Ankle-Clinic/124301104286092

Craig Hoffman - 11/25/2013 4:16:50

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