5 Common Causes of Joint Pain in the Big Toe

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 of the first metatarsophalangeal joint is described as hallux limitus or hallux rigidus.

• Hallux limitus is when the joint movement is limited.
• Hallux rigidus is when the joint becomes unusually stiff.

This makes it harder to straighten the big toe.

Osteoarthritis may develop from problems with foot structure or movement, resulting in excess wear and tear of the cartilage. This causes pain from the bone on bone rubbing when you move.

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

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

Sometimes it can be painful to walk, and people may develop an antalgic gait, which is an abnormal pattern of walking, to compensate. This can eventually lead to pain in the ankle, knee, hip, or lower back.

Knobby growths called bone spurs may develop. They tend to form on top of the big toe joint and they can create a hallux valgus deformity or they can develop on the top of the foot, causing pain when you wear tight shoes.

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 shoes that bend at the big toe joint.

Custom foot orthotics with a modification called Morton's extension can help when it's the motion that causes pain.

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

Surgery may be needed to remove the bone spurs. A cheilectomy is a bone fusion of the joint. Other procedures that might be indicated include joint replacement surgery, arthrodesis (a type of bone fusion), or a joint removal Keller procedure.

Bunion

A bunion is a large, knobby bump over the big toe joint. It usually causes a hallux valgus deformity, which is a deviation of the big toe towards the pinky toe.

The bunion can become larger towards the midline of your body, making it more painful in closed-toe shoes. Over time, the big toe drifts more towards the pinky toe, pushing and dislocating all the other toes.

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

Factors that contribute to bunions:

• Genetics
• Foot motion
• Tight shoes
• Rheumatoid arthritis

Treatment Options

There are things you can do to ease bunion symptoms.

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, you might consider a surgical procedure that can be done to reposition the bone and remove the bump. 

Gout

Gout can affect the big toe joint. Gout occurs when uric acid builds up in the 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 swollen, red, hot, and intensely painful joint. If gout attacks go untreated and occur repeatedly for a number of years, severe 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.

Gouty arthritis can resemble an infected joint, so your doctor may order a blood test to check your uric acid levels. If they're 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 blood uric acid levels.

For the toe, an acute gout attack can be treated with oral medication, including colchicine, an anti-inflammatory, or steroids. Sometimes a corticosteroid injection into the painful joint can help relieve symptoms.

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

• Cutting back on red meat, seafood, and alcohol
• Avoiding foods and drinks with high-fructose corn syrup
• Adding 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. And sometimes surgery can correct gouty arthritis damage.

Sesamoiditis

The sesamoid bones of the foot are two tiny bones located under the first metatarsal bone. They are part of 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 due to inflammation 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. Custom orthotics can have the padding embedded within the orthotic to offload the pressure to the sensitive sesamoids.

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. 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 the severity of the injury, symptoms can include swelling, discoloration, and pain.

Treatment Options

Treatment for turf toe entails resting the big toe joint and allowing it to heal. Custom orthotics with Morton's extension can reduce motion.

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.