Painful big toe joint

Posted on 18 Jul 2016 11:30:37

Pain at the metatarso-phalangeal joint of the big toe is very common, and is mostly due to one of three main causes

1.      Osteoarthritis (also known as Hallux Rigidus)

2.      Gout

3.      Painful bunion (associated with Hallux valgus deformity as in the picture above)

Hallux Rigidus (osteoarthritis)

This common condition is associated with a stiff and painful joint, sometimes with a bony lump on the top of the joint. Like osteoarthritis elsewhere in the body, it is caused by a wear and tear of the cartilage lining this joint. It is exacerbated by walking/ running and can sometimes quite severely limit walking distance. Treatment may involve simple change to comfortable shoes for minor cases, to injecting the joint with a steroid, to surgery. Steroid injections can sometimes provide some relief temporarily, but usually the pain comes back. We have had comrades marathon runners come to us for this injection prior to running the race to provide relief for the duration of the race. Surgical cheilectomy, ie removing the bony protruberance, can improve pain and range of movement. For severe cases, a reliable and permanent solution is to surgically fuse the joint, ie stick the joint together permanently. This sounds rather drastic, but results and function are good due to the reliable pain relief achieved.

Gouty Arthritis

The big toe MTPJ is one of the most common joints affected by Gout. The uric acid deposits in the joint and causes severe inflammation. Inflammation is characterised by severe pain, swelling, redness and restricted movement. It comes on suddenly, usually after a precipitating event, such as eating red meat/ drinking beer. Dehydration is a common accompaniment, therefore drinking lots of water at all times is important if you are known to suffer with Gout. Gout can be controlled with chronic medication, to keep the uric acid levels in the blood low, thus aiming to prevent acute attacks. Each acute attack damages the joint further and permanent joint destruction can occur. Chronic preventive treatment is recommended lifelong, just as you would take blood pressure medication for example. In chronic gout, tophi cause lumps to develop in the joint, which can be quite unsightly, can sometimes become infected and painful. Gout is a genetic disease but certain foods and alcohol are well known to precipitate attacks. Therefore a healthy diet and lifestyle is an important part of managing this condition. Acute severe attacks are best managed by taking large doses of anti-inflammatory medication, and sometimes steroids can help. For destroyed joints, surgical fusion of the joint is a way of achieving lasting pain relief. Note that gout can affect other joints, and even tendons.


Bunions are painful swelling over the joint, associated with a deformity of the big toe (Hallux Valgus), as in the above picture. This is a very common condition, and is usually well tolerated, with most people living with it without seeking medical treatment. If it is painful, modifications of shoe wear may help. Avoid narrow toe box shoes and high heels at all costs. If it does not settle, surgical options exist to remove the bony lump (bunion), and to correct the underlying deformity.