What Causes Pain in the Big Toe Joint?

5 Potential Causes for That Ache in Your First Metatarsophalangeal Joint

Pain in your big toe joint can make you miserable. The first metatarsophalangeal joint (1st MTPJ) is the joint that connects the big toe to the first metatarsal bone of the forefoot. Even though the joints of the toes are small, they are important for healthy foot functioning. These joints endure significant weight-bearing stress.

When they are hurting, you are in for a bad day. Some of the problems that most frequently occur at this joint include these five conditions:

1
Bunion

Elderly woman with bunions on her feet. Photofusion / Contributor / Getty Images

A bunion describes a large, knobby bump over the big toe joint that is associated with a common foot condition known as a hallux valgus deformity. Bunions are caused by a malpositioned big toe joint and not bony growths—a common misconception.

Besides a bump appearing, hallux valgus causes a shift in the big toe position, causing it to drift 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. While most bunions are due to faulty foot biomechanics, conditions such as rheumatoid arthritis can lead to a bunion deformity.

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

  • Wear wide, flat, and stretchable shoes that 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.
  • Perform stretching exercises to improve joint mobility.
  • After exercising on your feet, apply a cold pack over the bunion (be sure to put a paper towel between the pack and your skin).
  • Under the guidance of your doctor only, consider taking an anti-inflammatory, like ibuprofen, if your bunion is painful and/or swollen.

If your discomfort persists despite these simple measures, a doctor who specializes in foot conditions, called a podiatrist, can fit you with you special shoes called orthotics to support your big toe. Your podiatrist 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 endure pain and/or difficulties with walking, your podiatrist may refer you to a foot surgeon. There are a couple different surgical procedures that can be done to reposition the bone and remove the bump. 

 

2
Arthritis

Rheumatoid Arthritis
BSIP / Contributor / Getty Images

The most common form of arthritis that affects the big toe joint is osteoarthritis, caused by degeneration of the articular cartilage. 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 may include pain, a grinding sensation, stiffness, and swelling. The pain of osteoarthritis of the big toe is generally most noticeable when standing and walking. Some people with osteoarthritis of the big toe joint develop a condition called hallux rigidus, in which there is unusual stiffness of the joint, resulting in restricted big toe extension. 

If the arthritis advances, knobby growths called bone spurs may develop that resemble a bunion. The difference though is that while bunions develop on the inside of the foot, bony spurs from advanced arthritis tend to form on top of the big toe joint. Like bunions, though, these bony enlargements can create a hallux valgus deformity in which the big toe points towards the second toe.

Simple measures to treat arthritis of the big toe joint include taking an anti-inflammatory pain medication like an NSAID, under the advice of your personal physician and/or wearing shoes with a stiff sole and/or a bend at the big toe joint. 

Physical therapy can also be helpful and sometimes a steroid shot into the joint is needed to reduce pain and joint inflammation. Less commonly, surgery is needed, to remove the bone spurs (called cheilectomy) or bone fusion of the joint.

  

3
Gout

Senior man with gout. Peter Dazeley / Getty Images

Gout is a metabolic condition that can affect the big toe joint. Gout occurs when uric acid builds up in a person's blood, forming crystals, which then 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 and/or palpable urate deposits seen on the toe. 

Sometimes, it can be challenging for a doctor to distinguish between a gouty arthritis in the big toe joint and an infected joint. In this case, he or she 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—although, this is not a hard and fast rule, simply a clue. With that, often times, a doctor will need to take a sample of the fluid in the joint to test it for uric acid crystals—this allows for a more slam dunk diagnosis.

Treatment of gout in the big toe joint is two-fold, 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 (like an NSAID), or steroids.

To ease the 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
  • increasing dairy in your diet (low-fat), as well as vegetables and whole grain foods 

If you have multiple gouty attacks, your doctor may recommend a prescription medication to lower uric acid levels in the bloodstream.

4
Sesamoiditis

Grasping ball of foot before big toe and second toe. Dorling Kindersley / Getty Images

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

The sesamoid bones are subject to pain and inflammation from acute or chronic trauma. Sesamoiditis is often linked to activities that involve balancing on toes or jumping, such as ballet dancing or basketball. Fracture of a sesamoid bone can cause similar symptoms, often significant pain under the ball of the foot, in the area under the big toe joint.

Sesamoiditis can be a stubborn condition to treat because of the amount of weight-bearing pressure on the ball of the foot during walking. In fact, more severe cases of sesamoiditis or fracture of a sesamoid bone may require non-weight bearing with crutches or a cast. Sesamoid fractures may require surgery.

Sesamoiditis that is not associated with a fracture or soft tissue tear may be treated with rest from activity, padding around the ball of the foot, and shoe orthotics (arch supports) to relieve ground pressure from the ball of the foot. Shoe recommendations may be given, such as a hard-soled shoe or a rocker-bottom shoe. A rocker-bottom shoe is similar to a toning shoe, in that they both have a curved sole which decreases pressure on the bottom of the toes.

5
Turf Toe

Woman's foot wrapped in brace for injured toe, low section : Stock Photo CompEmbedShareAdd to Board Woman's foot wrapped in brace for injured toe. PhotoAlto/Odilon Dimier / Getty Images

Turf toe is a common sports-related injury, and like sesamoiditis is characterized by pain on the bottom of the big toe joint. The pain stems from a sprain, which is an injury or tear of a ligament in the toe. 

The name turf toe comes from the link between this injury and sports played on artificial turfs, such as football and soccer. The injury occurs when the toe endures excessive force while flexing, such as when an athlete pushes off from the big toe when cutting and 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 degree of injury, symptoms often include some form of swelling, discoloration, and pain. Treatment for turf toe is similar to sesamoiditis, centering on decreasing stress on the big toe joint in order to allow healing. For the acute strain, ice, elevation, protection of the foot, and sometimes crutches are needed. More severe injuries may need to be referred to a foot surgeon. 

Sources:

American Academy of Orthopedic Surgeons. (March 2015). Arthritis of the Foot and Ankle. 

American Academy of Orthopedic Surgeons. (September 2012).  Stiff Big Toe (Hallux Rigidus).

Becker MA. (February 2017). Patient education: Gout (Beyond the Basics). In: UpToDate, Dalbeth N (Ed), UpToDate, Waltham, MA. 

Doherty M, Abhishek A. (January 2017). Clinical manifestations and diagnosis of osteoarthritis. In: UpToDate, Hunter D (Ed), UpToDate, Waltham, MA.

Fields KB. (November 2016). Evaluation and diagnosis of common causes of foot pain in adults. In: UpToDate, Eiff P (Ed), UpToDate, Waltham, MA. 

 

 

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