Swollen Big Toe

From arthritis to gout, many different conditions can cause fluid to build up, resulting in a swollen big toe (hallux edema). While some types of big toe swelling can be managed with over-the-counter (OTC) interventions, others require more invasive treatments by a healthcare provider.

This article will discuss the most common causes of hallux edema, the symptoms that typically accompany it, and the treatments that are available for it.

Symptoms of a Swollen Big Toe

Along with swelling in the big toe, other symptoms may be present. These include:

• Intense pain or sensitivity
• Warmth or redness
• Hardened skin on the bottom of the foot or along the base of the big toe
• Stiffness or limited range of motion
• Development of a bony lump or prominence
• Soreness during the push-off phase of walking

Causes of a Swollen Big Toe

A wide variety of diagnoses can cause swelling in the big toe. Among the most common are:

• Gout
• Bunions (hallux valgus)
• Osteoarthritis (hallux rigidus)
• Traumatic injury

Swelling may be seen if you have jammed your big toe, dropped a heavy object on it, or had a cut or bite on the toe.

Gout occurs when high uric acid levels cause microscopic urate crystals to build up in one or several of the body’s joints. The big toe is the location most commonly impacted by this condition.

As the needlelike uric acid crystals accumulate in a joint, they irritate and inflame the surrounding tissue, causing swelling to develop. In addition to causing big toe swelling, gout typically leads to sharp, stabbing hallux pain that can progress rapidly and without warning. Warmth and redness in the same region are also very common.

In many cases, the exquisite toe tenderness associated with this issue can make it very difficult to walk, wear a shoe, or even cover the foot with a bedsheet.

A bunion is a bony prominence that develops along the inner border of the base of the big toe. While the causes of this condition are not completely understood, it tends to progress slowly as the hallux gradually angles toward the rest of the toes.

When this occurs, a bony protrusion develops on the inner foot, which can frequently rub against the inside of your shoe. This repetitive friction often leads to inflammation and swelling around the base of the big toe.

While some bunions cause no symptoms, advanced bony prominences tend to rub against the inner border of your shoe. In addition to causing big toe swelling, this increased friction can lead to the development of hardened or callused skin along the bottom or inner border of the foot.

In addition, redness and pain commonly occur, and the range of motion in the big toe may become limited.

The joint at the base of the big toe (called the first metatarsophalangeal, or first MTP joint) is a common area for osteoarthritis to develop. This degenerative condition (called hallux rigidus) occurs when the smooth, slippery cartilage that lines the endings of bones begins to thin or deteriorate.

As this happens, friction increases as the bones move against one another, and bone spurs begin to develop in the joint. These spurs often lead to stiffness and swelling in the big toe.

Osteoarthritis in the first MTP joint commonly causes pain or soreness in the hallux as you push off your foot or participate in more active tasks. A bony prominence or bump may also begin to protrude from the top portion of the first metatarsophalangeal joint.

In addition, stiffness can develop in the joint and make it difficult to move your first toe up and down.  

How to Treat a Swollen Big Toe

Several at-home treatments can effectively alleviate the swelling caused by osteoarthritis or a bunion, though the relief may be temporary. These interventions include:  

• Icing the area
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil or Motrin (ibuprofen) or Aleve (naproxen)
• Modifying footwear to avoid narrow, high-heeled, or flexible-soled shoes.
• Using padding or toe spacers if a bunion is present.

In advanced cases of hallux osteoarthritis, surgery is sometimes needed to remove a bone spur (called a cheilectomy) or to fuse or replace the first MTP joint. Bunions causing pain and swelling may also need a surgical procedure to realign the first toe.

In the case of gout, some at-home remedies may also be helpful. These include taking NSAIDs and eating or drinking uric acid–lowering foods like cherries or skim milk.

In many cases of gout, more potent pain-relieving medications, like corticosteroids, or uric acid–lowering drugs, like Colchrys (colchicine), are needed. In addition, an inflammation-reducing steroid injection may also be administered if medication fails to effectively alleviate the big toe swelling.

Risk Factors Associated With Big Toe Swelling

Several risk factors make you more likely to develop big toe swelling from gout. These include:

• Sex (gout is more common in people assigned male at birth vs. those assigned female up until postmenopause, when incidence levels out between sexes)
• Kidney disease
• Obesity
• High blood pressure or high cholesterol
• Family history of gout

The risk factors for developing hallux valgus are a little less definitive. Bunions seem to occur more in people with a family history of the condition, in those who consistently wear poorly-fitting shoes, and in individuals who also have an inflammatory or neuromuscular condition (like rheumatoid arthritis or polio).

Along the same lines, it is not completely clear why hallux rigidus affects some people and not others. The condition tends to develop in individuals between ages 30 and 60. Prior foot injuries or anatomical variations in the foot or toes can also increase the likelihood of osteoarthritis-related swelling.

Are There Tests to Diagnose the Cause of Big Toe Swelling?

A healthcare provider will commonly use several different clinical tools to determine the cause of your big toe swelling. In addition to a physical exam, the following tests may be ordered:

• X-ray: Assesses big toe alignment when diagnosing a bunion and looks for osteoarthritis in the first MTP joint
• Magnetic resonance imaging (MRI): Provides a detailed look at the toe to investigate a possible bone infection, fracture, or abscess
• Joint aspiration (arthrocentesis): Uses a needle to draw fluid from the affected joint and examine it microscopically for urate crystals when diagnosing gout
• Blood tests: Assess uric acid levels in the body when looking for gout

When to See a Healthcare Provider

While low levels of swelling in the big toe can often be self-managed at home, new or progressively worsening swelling should be reported immediately to a healthcare provider.

This is especially true if the swelling arises after an injury or is accompanied by sharp pain, redness, or warmth in the toe. These symptoms could indicate a more serious concern and should be evaluated promptly. Failing to do so could potentially aggravate the condition or prolong your recovery.

Summary

Many conditions can cause big toe swelling, including osteoarthritis, bunions, gout, and traumatic injury. If you experience increased fluid in the great toe, it may also be accompanied by other symptoms like bony deformity, pain, stiffness, warmth, redness, or callus formation.

Some types of swelling can be addressed with self-care and over-the-counter treatments like icing or NSAIDs, others require medical interventions like an injection or surgery.

It is important to speak to a healthcare provider about any fluid buildup you are experiencing in your foot. Taking this first step can help diagnose your problem's cause and identify the right treatments for you.