Pain in the big toe joint may result from various health problems, including arthritis, injuries, and bunions. Treatment will depend on the cause, but applying cool packs, raising the foot, and gentle foot exercises may provide relief.
The metatarsophalangeal (MTP) joint attaches the big toe to the foot. This joint is vital for supporting the body and allowing the toe to bend up and down. It helps propel a person forward by acting as a push-off point when they walk or run.
Conditions that affect the MTP joint can cause pain and swelling around the big toe. Pain at this joint can limit movement in the area and affect a person’s ability to walk.
This article discusses some of the causes of pain at the big toe joint and how to treat them.
Big toe joint pain from osteoarthritis (OA) can cause pain in the foot while walking, often causing a limp. The joint may be swollen and tender to the touch. There may also be numbness at the base of the joint due to compression of the nerve.
Hallux rigidus occurs when the movement of the big toe becomes painful and difficult. The range of motion becomes particularly limited when the toes bend back, such as during the “tiptoe” stage at the end of a step when walking.
If hallux rigidus is mild, pain will often occur just when the toe reaches the end of the range of motion. Pain at the midrange of motion can signal more severe arthritis.
OA is a form of arthritis that occurs when the cartilage wears down at the joints. Over time, OA in the big toe will cause the cartilage to erode and the bones to rub against each other. The friction causes pain and inflammation.
Gout causes big toe joint pain, such as intense attacks, or flares, that come and go. These attacks of sharp pain may start during sleep. A person may experience severe pain when anything touches the foot.
A gout flare may last for
Gout is also a type of arthritis. It occurs when uric acid crystallizes in the joints. Uric acid is a waste product that goes through the bloodstream before passing through the kidneys and out of the body as urine.
High levels of uric acid can lead to crystallization and the formation of small deposits. When this occurs in the joints, it can be very painful.
Gout may occur in other parts of the body besides the feet. Over time, it can cause lumps to form under the skin in the affected areas.
Toe injuries, such as sprains and fractures, can cause pain and swelling at the toe joint. A fracture or sprain can be particularly painful when a person is walking or bearing weight with the foot.
Sprains can reduce the range of motion or cause pain in the joint when the range of motion is tested. A sprain occurs when the ligaments in the toe become torn or stretched. This can be due to turf toe, a common sports injury that occurs as a result of excessive or repetitive pressure on a bent toe.
Fractures can be chronic or acute. Chronic fracture pain can come and go and worsens with activity. Acute fracture pain is immediate at the time of injury.
A stress fracture is a small crack in the bone that develops as a result of repetitive force, an example of a chronic injury. A toe fracture can also come from a single, intense blow to the area, which would be an acute injury.
Fractures can cause bruising of the area extending beyond the toe joint to nearby parts of the foot.
Bunions can cause tenderness, swelling, and pain around the big toe joint. This pain is particularly acute when someone is walking or wearing tight-fitting shoes. This is because a bunion results from inflammation in the MTP joint, which flexes when a person walks.
A bunion is a bony lump that develops along the inner side of the foot. Bunions start out small but become larger over time, especially with repeated wearing of narrow or tight shoes. They can lead to stiffness and restricted flexibility.
Occasionally, a bunion may cause the big toe to turn toward the second toe, which health experts refer to as a hallux valgus deformity.
Bunions can occur in anyone, but they are more common in people who wear shoes that are tight around the toes.
Sesamoiditis in the foot can cause pain at the base of the big toe, on the ball of the foot. This is on the underside of the foot and not the top. The condition can also lead to to swelling or bruising.
The toe may be particularly sensitive when it is bent or straightened. The pain develops gradually over time.
Sesamoiditis is inflammation in the tendons surrounding the sesamoid bones. This is a form of tendinitis. It can also result from fracture of the sesamoid bones. The condition often results from overuse of the toe. Ballet dancers and runners often develop sesamoiditis.
The sesamoid bones in the foot sit beneath the MTP joint. Tendons attach to these bones and support movement in the area.
The type of treatment will depend on the cause of the big toe joint pain.
In many cases, a doctor will recommend a pain reliever, such as a nonsteroidal anti-inflammatory drug. These medications may also help reduce swelling in the area. Less commonly, a doctor may prescribe corticosteroids to reduce inflammation.
Lifestyle changes may also be necessary. For example, a person may need to treat a bunion by wearing orthopedic shoes or shoe inserts. Wearing shoes with extra room for the toes is a good option for people with this problem.
A doctor may recommend wearing a protective boot while a toe fracture heals.
If the injury is the result of a particular activity, it will often be necessary to avoid that activity while the injury heals. For instance, treating turf toe may involve avoiding the sport that caused the injury until it improves.
In some cases, it may be important to reach a moderate body weight to reduce pressure on the toe.
More specific treatments may be necessary for certain conditions, such as OA and gout. Physical therapy may help individuals with arthritis manage this condition.
In rare cases, surgery may be necessary — for example, to remove a bunion or repair joint damage.
Some types of big toe joint pain, such as very painful gout or fractures, require immediate medical attention.
In many cases, home remedies can relieve big toe joint pain or supplement therapy that a doctor has recommended. The following remedies can help manage toe joint pain:
- resting the foot
- elevating the foot
- icing the foot for 20 minutes every 2–3 hours
- using a compression bandage to reduce swelling
- wearing comfortable, wide shoes with a soft sole and no heel
- placing pads or soft soles inside shoes
- gently stretching the foot muscles
A doctor can recommend the best pain reliever. Acetaminophen (Tylenol) is one possible option.
To determine the cause of pain at the big toe joint, a doctor will perform a physical examination and ask a person about their symptoms, lifestyle, medication, and any recent injuries.
They may test the flexibility of the toe by gently bending it up and down. They will also look for evidence of bone spurs and swelling in the area.
The doctor will then examine the foot for areas of tenderness and check the skin to see whether any sores are present.
In some cases, it may be necessary to do an X-ray. This imaging test will help the doctor assess the location and extent of any damage or deformity.
Depending on the underlying cause of the pain, further testing may be necessary. For instance, a blood test can measure the level of uric acid in the bloodstream to help diagnose gout.
Some tips for preventing pain at the big toe joint include:
- reaching or maintaining a moderate body weight
- exercising regularly without placing excessive strain on the MTP joint
- remembering to warm up before intense workouts
- avoiding wearing high heels or shoes that are too tight, particularly around the toes
- wearing appropriate footwear when at risk of injury, meaning wearing steel-toe boots in a warehouse
- avoiding smoking, as smoking can negatively affect the mass of a person’s bones, making them more prone to osteoporosis or injury
- reducing consumption of caffeine, which can weaken a person’s bones
- being particularly careful when carrying anything heavy
- increasing consumption of calcium
- increasing consumption of vitamin C, which may help reduce arthritis symptoms
In cases of mild pain or pain that gets better over time, it is not usually necessary to seek guidance from a doctor. Many sprains will heal on their own during a period of rest.
The Arthritis Foundation recommends contacting a doctor for joint symptoms that do not improve after 3 days or if a person has several joint symptoms within a single month.
It is also important to consult a doctor if the pain is severe or sudden and unexplained. A medical professional should examine the foot when there are signs of fracture, such as bruising around the big toe.
Pain in the big toe joint can be due to trauma, a chronic condition, or pressure that has built up over time. In many cases, the underlying cause is easily treatable.
Some injuries can heal on their own with rest and pain medication. However, some conditions, such as OA and gout, require long-term solutions.
It is possible to reduce the risk of toe injuries by making simple lifestyle changes, such as wearing appropriate footwear.
Anyone with pain at the big toe joint that gets worse over time or does not resolve should contact a doctor.