5 Common Causes of Pain in the Big Toe Joint

Sources of aches in your first metatarsophalangeal joint

Pain in your big toe joint can make you miserable. The first metatarsophalangeal joint is the joint that connects the big toe to your foot's first metatarsal bone. Even though your toe joints are small, they play an crucial role in how your foot works.

These joints have to carry a lot of your body weight, so when they are hurting, you are in for a bad day. This article lists five common conditions that cause pain in your big toe joint along with what you can do to ease it.

causes of pain in the big toe joint

Verywell / Emily Roberts

Bunion

A bunion is a large, knobby bump over the big toe joint that often occurs with a common foot condition called hallux valgus deformity.

Besides a bump appearing, hallux valgus causes the big toe to shift its position toward the lesser toes over time.

The usual result is a widened forefoot and a red, irritated, and sometimes swollen bump on the side of the big toe joint.

Some think that bunions are caused by bony growths, but that's not true. They develop when the big toe joint becomes displaced.

While most bunions are caused by problems with how the foot moves, conditions such as rheumatoid arthritis can lead to a bunion deformity as well.

Treatment Options

The good news is that there are things you can do to ease bunion symptoms if you have one (or two). Here are a few strategies to consider:

  • Wear flat, stretchable shoes with a wide toe box to allow extra space around the big toe. This will reduce pressure on the bunion.
  • Place a pad over the bunion to prevent rubbing and irritation.
  • Stretch to improve joint mobility.
  • After exercising on your feet, apply a cold pack over the bunion (be sure to put a paper towel or cloth between the pack and your skin).
  • If your bunion is painful or swollen, talk to your doctor about whether you should take an anti-inflammatory like Advil (ibuprofen).

If your discomfort persists despite these simple measures, a podiatrist (a doctor who specializes in foot conditions) can fit you with special shoe inserts called orthotics to support your big toe. They may also provide you with toe splints that you wear at night to realign the big toe while you sleep. 

If these measures do not work and you still have pain or difficulty walking, your podiatrist may refer you to a foot surgeon. There are a couple of different surgical procedures that can be done to reposition the bone and remove the bump. 

Arthritis

The most common form of arthritis that affects the big toe joint is osteoarthritis. This is caused by a breakdown of the tissues that cover the ends of bones where they meet at the joint.

Osteoarthritis at the big toe joint may develop from problems with foot structure and functioning, resulting in excess wear-and-tear.

Trauma, such as a fracture or dislocation of the big toe, can also result in osteoarthritis. Other less common types of arthritis that affect the big toe include rheumatoid arthritis and psoriatic arthritis.

Symptoms of arthritis of the big toe joint may include pain, a grinding sensation, stiffness, and swelling. With osteoarthritis of the big toe, the pain is generally most noticeable when standing and walking. 

Some people with this type of osteoarthritis develop a condition called hallux rigidus, in which the joint becomes unusually stiff. This makes it harder to straighten the big toe.

If the arthritis gets worse, knobby growths called bone spurs may develop. They look like bunions, but bunions develop on the inside of the foot, whereas bone spurs tend to form on top of the big toe joint.

Like bunions, bone spurs can create a hallux valgus deformity, in which the big toe points towards the second toe.

Treatment Options

If your doctor gives you the go-ahead, taking an anti-inflammatory pain reliever like ibuprofen can help ease arthritic pain in your big toe joint. Your doctor may advise you to wear shoes with a stiff sole or that bend at the big toe joint.

Physical therapy can also be helpful, and a steroid shot into the joint is sometimes needed to reduce pain and joint inflammation.

Less commonly, surgery is needed to remove the bone spurs. This surgery is called a cheilectomy, or more simply, a bone fusion of the joint.

Recap

Problems in your foot's structure or with how it moves can lead to bunions and osteoarthritis bone spurs. Both are painful, knobby bumps that form at the big toe. Though similar in appearance, they are treated differently.

Gout

Gout is another condition that can affect the big toe joint. Gout occurs when uric acid builds up in a person's blood, forming crystals that get deposited into a joint, commonly the big toe joint. The medical term describing gout in the big toe joint is podagra.

Symptoms of gouty arthritis include a red, hot, and intensely painful joint. If gout attacks go untreated and occur repeatedly for a number of years, joint damage may occur. In addition, gout tophi may form, which are visible deposits of uric acid on the toe. 

Uric acid is a waste product in your blood that your body makes after it breaks down purines, which are substances found in some foods. If your kidneys cannot get rid of the uric acid properly, urate crystals can form and lead to gout.

It can sometimes be challenging for a doctor to tell if a toe is affected by gouty arthritis or an infected joint. In this case, your doctor may order a blood test to check the uric acid levels in your bloodstream. If elevated, this can be a clue that a gout attack is occurring.

Doctors often need to take a sample of the fluid in the joint to test it for uric acid crystals and make a diagnosis.

Treatment Options

Treatment for gout in the big toe joint entails treating both the toe and the high uric acid levels in the bloodstream. For the toe, an acute gout attack can be treated with a prescription medication called colchicine, an anti-inflammatory, or steroids.

To ease gout and prevent future attacks, your doctor will likely recommend losing weight if you are overweight or obese and making dietary changes like:

  • Cutting back on red meat, seafood, and alcohol
  • Avoiding foods and drinks with high-fructose corn syrup
  • Adding more low-fat dairy, vegetables, and whole-grain foods into your diet

If you have multiple gouty attacks, your doctor may prescribe a medication that lowers uric acid levels in the bloodstream.

Sesamoiditis

The sesamoid bones of the foot are two tiny bones found under the first metatarsal bone, near the big toe joint. They sit within a tendon that flexes the big toe down.

The sesamoid bones are prone to pain and inflammation (sesamoiditis) when there is acute or chronic trauma. Sesamoiditis is often linked to activities that involve balancing on toes or jumping, such as ballet dancing or basketball.

Fracturing the sesamoid bone can cause similar symptoms, often with significant pain under the ball of the foot and under the big toe joint.

Treatment Options

Sesamoiditis can be tough to treat because the ball of the foot has to bear a lot of body weight when you walk.

Sesamoiditis that is not due to a fracture or soft tissue tear may be treated with rest, padding around the ball of the foot, and shoe orthotics (arch supports) to take pressure off the ball of the foot.

Your doctor or physical therapist may recommend that you wear hard-soled shoes or a rocker-bottom shoe. A rocker-bottom shoe has a curved sole, which relieves pressure off the bottom of the toes.

In severe cases, or when the sesamoid bone is fractured, you may need to take weight off the bone by using crutches or wearing a cast.

Sesamoid fractures may require surgery.

Turf Toe

Turf toe is a common sports-related injury. Like sesamoiditis, it creates pain on the bottom of the big toe joint. The pain stems from a sprain or tears to a ligament in the toe.

Turf toe is often seen in athletes who play sports on artificial turf, like football and soccer. The injury occurs when the toe endures intense force while flexing, such as when an athlete pushes off from the big toe when running. 

The conditions of the hard turf, athletic shoes, and stress on the toe from running may all contribute to this injury. Depending on how severe the injury is, symptoms can include swelling, discoloration, and pain.

Treatment Options

Treatment for turf toe is similar to sesamoiditis. It entails resting the big toe joint and allowing it to heal.

For an acute strain, you may need to ice, elevate, and possibly use crutches. For more severe injuries, you may need to be referred to a foot surgeon.

Recap

Any acute or chronic injury to the big toe or its joint can cause pain and swelling. Sometimes, a chronic illness like gout can affect the big toe, in which case you will need a specific treatment plan and, often, prescription medicine.

Summary

Pain in your big toe joint can be caused by injuries like turf toe, problems with how your foot moves, or diseases like osteoarthritis and gout.

The treatment you receive depends on what is causing your big toe joint pain. In some cases, you may be able to heal your big toe joint with rest, ice, and sometimes crutches. For more severe cases, you may need surgery.

A Word From Verywell

If your feet aching, there's a good chance your shoes could be to blame—especially if you spend a lot of time on your feet. Wearing properly-fitted shoes can help prevent pain and injuries in your feet later on.

Just as no two people are the same, neither are their feet. As such, not every shoe on the market will be the right fit for you.

You may benefit from going to a shoe store that can examine the shape of your feet and how you walk, then fit your foot to a shoe that properly supports your foot. Speciality running shops are a good place to start (even if you're not a runner).

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2 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  2. Sims AL, Kurup HV. Painful sesamoid of the great toe. World J Orthop. 2014 Apr;5(2):146-50. doi:10.5312/wjo.v5.i2.146