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5 Top Reasons for Painful Big Toe Joint Pain

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Gout, osteoarthritis, toe injuries (like turf toe, strains and fractures) or bunions, and sesamoiditis – any of these can cause big toe joint pain. And like most pain, movement – walking included – doesn't allow much relief. Even though toe joints are small, they play a prime role in how the foot functions. The metatarsophalangeal joint attaches the big toe to the foot. This joint is essential for body support and allows the toe to bend up and down. It’s what helps move a person forward by acting as a push-off when they walk or run.

Here are some common issues that can arise with the “big toe” joint, suggestions on how to treat them and tips on pain prevention.


A form of arthritis, gout happens when uric acid builds up in the blood, forming crystals that get deposited into a joint. Any joint in the body can be affected, but pain typically begins in the big toe according to the American College of Rheumatology. Symptoms include pain, swelling and tenderness around the big toe. The area could be inflamed, hot and discolored. The onset of symptoms can be sudden and severe, especially at night.

Gout is linked to diet and certain medical conditions such as:

  • metabolic syndrome
  • diabetes
  • congestive heart failure
  • obesity
  • hypertension


If the gout attack is minimal, it can be treated with oral medication like anti-inflammatories or steroids. Sometimes a corticosteroid injection into the joint can help relieve symptoms. Oral medications like colchicine and indomethacin are often prescribed.

To prevent future attacks, a doctor will most likely recommend weight loss along with some other diet changes like:

  • Adding low-fat dairy, vegetables and whole grains to your diet
  • Cutting back on red meat, seafood and alcohol
  • Avoiding foods and drinks with high-fructose corn syrup
  • Oral allopurinol may often be prescribed by your physician for prevention


Osteoarthritis is the most common form of arthritis that causes big toe joint pain. It occurs when the tissues that cover the ends of the bones break down at the joint. Developing from issues with foot structure or movement, Osteoarthritis results in excess wear and tear of the cartilage, causing bones to rub against one another during activity. Symptoms of arthritis in the big toe can include pain, grinding sensations, swelling and stiffness – all more noticeable when standing or walking. According to the College of Foot and Ankle Surgeons, those with fallen arches or pronated feet/ ankles may be more likely to develop this condition.


An anti-inflammatory like ibuprofen can help with big toe arthritic pain. Shoes with a stiff sole, soft stretchable uppers or bend at the toe joint could be beneficial as well. Other non-surgical treatments include:

  • Ice and heat
  • Steroid/ platelet-rich plasma injections
  • Physical therapy

Surgery is also an option and may include:

  • Joint replacement
  • Joint resurfacing
  • Fusing the joint

Toe Injuries (Sprains, Turf toe, Fractures)

Common injuries like sprains and fractures can cause big toe joint pain and swelling. Sprains happen when ligaments in the toe are torn or stretched. Sprains can reduce the range of motion during physical activity. Turf toe, a common sports injury, occurs as a result of repetitive pressure on a bent toe.

Fractures, depending on how severe, can cause bruising beyond the toe joint to other parts of the foot. They can be lingering (pain comes and goes), or more intense where pain is immediate at the time of injury.

Symptoms of big toe joint pain due to an injury can include:

  • Throbbing pain
  • Bruising
  • Swelling


Doctors will recommend resting as much as possible and to avoid putting pressure on the foot. For protection and support, wear shoes with a stiff sole and padding. Take over-the-counter medications for pain and swelling and apply a cold compress a couple of times a day. Remember R.I.C.E. – rest, icing, compression and elevation. For severely broken toes, doctors may suggest a walking boot or surgery.


A bunion is a bony lump that develops along the inner side of the foot. Bunion pain is the direct result of inflammation in the MTP joint. Bunions can start small and become larger over time, especially with the use of narrow or tight-fitting shoes. They can cause pain, irritation and swelling at the base and side of the toe joint making movement difficult and uncomfortable. Several factors can cause bunions including:

  • Ill-fitted shoes
  • Standing for extended periods
  • Arthritis
  • Genetics
  • Improper foot motion


To reduce pain, take a nonsteroidal anti-inflammatory like ibuprofen or aspirin. And wear shoes that don’t put pressure on the joint – wide and flexible uppers are best. Some additional treatments may include:

  • Bunion pads to prevent rubbing and irritation
  • Icing the joint
  • Stretching to improve joint mobility

If these don’t work, a podiatrist could recommend special shoe inserts that support the big toe. They may also provide toe splints to wear at night. These work to realign the big toe while you sleep. In extreme or persistent cases, steroid injections and/ or surgery may be suggested.

Sesamoiditis (seh-suh-moy-dai-tuhs)

The American Academy of Orthopaedic Surgeons describes sesamoids as bones that are not connected to any other bone, but instead connect only to tendons or are embedded in muscle. There are very few in the body – the kneecap is the largest. There are two other considerably smaller ones found on the underside of the foot near the big toe.

Sesamoiditis is the swelling of the tendons surrounding these tiny bones and often results from overuse of the toe (think ballet dancers and professional runners). Symptoms may include a dull pain under the big toe joint that comes and goes, bruising, inflammation or trouble moving the big toe.


Treatment is typically nonsurgical. However, if nonsurgical treatments don’t work, a doctor may opt for surgery to remove the sesamoid bone. Recommendations include:

  • Stopping the activity that causes pain
  • Resting and applying a cold compress
  • Wearing supportive footwear or cushion inserts
  • Taking NSAIDs to help with pain and inflammation – corticosteroid injections are also a possibility
  • Strapping, padding, offloading or taping the toe and/or foot
  • Physical therapy
  • Crutches or a walking cast can help to relieve the pressure and provide comfort if a doctor recommends restricted movement of the toe or foot.

Big toe joint pain prevention

Big toe joint conditions are both painful and inconvenient. But many causes are treatable. In most cases, a person can expect a full recovery if they rest from the activity that caused the pain. However, certain genetic or more severe conditions may require surgery or other treatments.

Follow these basic prevention tips for healthy and happy big toe joints:

  • Reaching and maintaining a healthy weight
  • Exercising regularly without excessive strain on the “big toe” joint
  • Avoiding high heels (narrow toe) or shoes that are too tight
  • Wearing appropriate footwear when at risk of injury whether at a job site or other location
  • Taking caution when lifting or moving something heavy
  • Increasing intake of calcium (helps to build strong bones)
  • Increasing intake of vitamin C (helps reduce arthritis symptoms)

When to see a doctor

While many toe injuries will resolve themselves over time, seek medical attention for any pain lasting more than 2 weeks or if several occur over a short period. It is also important to consult a doctor if the pain is unexplained, severe or sudden. Be on the lookout for signs of infection that could include:

  • Pus
  • Feeling hot or shivery
  • Unusual swelling

Talk to your doctor if your foot pain interferes with daily activities or worsens over time. They can help decide on the best treatment plan.

Learn more about podiatrist GaChavis, Green, DPM

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