Big Toe Joint Pain: Causes, Seriousness, Relief

Pain in the joint of your big toe is a fairly common issue that generally requires some level of medical attention. This joint, also called the metatarsal phalangeal (MTP) joint, is located at the base of the toe and connects the toe to your foot.

Pain in this joint can vary in intensity and onset. The pain can develop due to different conditions, including osteoarthritis, bunions, and gout. How urgently you should see a healthcare provider depends on the cause.

Understanding the causes of pain in the big toe joint can help you know when and how to get the care you need.

Several conditions can cause pain in the big toe joint. A healthcare provider can help diagnose the cause of your pain.

1. Bunions

A bunion is a large bony bump that can form at the side of your foot near the MTP joint, causing the joint to bulge and stick out. Not everyone with bunions experiences pain in the MTP joint, but pain is a symptom for many.

The area may become painful from rubbing against your shoes. The bones of the big toe become slanted, as do some other foot bones. The friction from the bunion may lead to inflammation called bursitis near the MTP joint, which can lead to additional pain at the base of the big toe, especially when walking.

Bunions become more common with age, and up to a third of people over 65 have them. Women are at higher risk, especially those who have often worn constricting and high-heeled shoes.

2. Osteoarthritis (Hallux Rigidus)

Osteoarthritis is a form of arthritis (pain and inflammation of the joints) caused partially by aging and general wear and tear on your joints. Osteoarthritis of the MTP joint in the big toe also goes by the name hallux rigidus, which means “rigid big toe” in Latin. It’s the most common arthritic condition of the foot, affecting 2.5% of adults over 50.

Hallux rigidus typically causes gradually increasing pain and stiffness of the joint. The pain worsens with physical activity, particularly activity that requires bending the toe up, like using stairs or doing push-ups. The joint eventually loses range of motion and becomes more rigid.

It’s not clear what causes hallux rigidus, which tends to affect the big toes of both feet, but many people have a family history of the condition.

3. Gout and Inflammatory Arthritis

Gout is a different type of arthritis that causes joint swelling, pain, and tenderness. Crystal deposits in the joint cause gout. It’s more common in men aged 30-50. Illness, dehydration, and excess alcohol intake can trigger gout.

Gout tends to affect just one joint in its early stage. The MTP joint is the first affected in roughly 50-75% of people. The pain usually starts quickly and severely, which may help distinguish it from other kinds of pain in the big toe joint. 

Other types of inflammatory arthritis, like rheumatoid arthritis, might also cause pain in the big toe’s MTP joint. However, it would be unusual for these other types of arthritis to cause pain in that specific joint alone.

4. Sesamoiditis

Sesamoiditis is pain and swelling of the tendons surrounding the sesamoid bones. These are two small bones inside a tendon just beneath the MTP joint, on the side closer to the bottom of the foot. It’s a type of tendinitis (inflammation of the tendons).

Sesamoiditis can cause gradually increasing pain in the MTP joint with movement, especially when walking or bending and straightening the toe. It also decreases the joint’s strength and range of motion. Depending on the circumstances, the pain might come on gradually or more suddenly.

Sesamoiditis can sometimes result from osteoarthritis or another type of chronic arthritis. It can also happen in athletes when repetitive running and jumping activities damage the foot over time.

5. Trauma and Injury

Turf toe is the nickname for a sprain of the ligaments on the bottom of the MTP joint. It can happen when the toe is bent strongly upward with too much force. It’s particularly common in athletes who play on artificial turf, hence its nickname.

You may have signs of injury, like redness and swelling. In more severe cases, the joint might be unstable, and you might not be able to move it easily. 

Another related injury is sand toe, a nickname for a sprain of the ligaments on the opposite side of the MTP joint. It can cause similar symptoms, and it’s particularly common among volleyball players who play on sand courts.

Many other kinds of trauma can cause pain around the MTP joint, such as a fracture (broken toe), which can happen from dropping something on the toe, stubbing the toe, or other injuries.

6. Infection

Infection is a rare cause of pain and swelling in the MTP joint, which can lead to a serious medical condition called sepsis. The joint pain and swelling usually occur with fever and no history of injury.

This kind of joint infection is rare unless you’ve recently had joint surgery or a skin infection such as staph or you have significant risk factors for infection.

If you have any kind of big toe pain, it’s a good idea to make an appointment with a healthcare provider. Delaying treatment can often lead to problems that are more difficult to treat later.

It’s also important to get immediate medical attention if you have an injury that causes severe pain in the MTP joint or difficulty moving the joint. If your joint pain started suddenly and is strong or if you have big toe pain with fever, you should also seek immediate treatment.

A healthcare provider may use a physical exam, imaging tests, and blood tests to diagnose the pain in your MTP joint.

Physical Exam

Your healthcare provider will likely ask for your medical history, including recent symptoms and activities, like playing sports, that could have triggered the pain. During the physical exam, they’ll examine the joint and related structures, evaluating for factors like swelling, redness, strength, range of motion, and normal sensation.

Imaging Tests

Imaging techniques are often needed as well. Your provider may start with an X-ray, which can give basic information about the bones. An ultrasound can give additional information about damage to soft tissues around the joint. 

Some people may require precise imaging tests to get the most detailed information about the MTP joint area, especially after an injury. In these cases, your provider may request a magnetic resonance imaging (MRI) scan.

Blood Tests and Other Tests

If your healthcare provider suspects you may have inflammatory arthritis or an infection, you might need other tests. These can include basic blood tests to check for general signs of inflammation or infection and blood culture tests to identify specific infectious organisms.

Rarely, you might need a procedure to remove fluid from your joint, particularly if your provider thinks you have a joint infection or a diagnosis isn’t clear.

Treatment for your pain can vary based on the underlying cause, its severity, your other health conditions, and your personal preferences. Depending on the circumstances, you may need to work with a specialist such as a podiatrist (foot specialist), rheumatologist (specialist in inflammatory diseases), or orthopedic physician (specialist in musculoskeletal injuries).

Change of Shoes or Activity

Shoe modifications, orthotics, and activity adjustments can be helpful for many. For a bunion, wearing shoes that are roomy allows you to avoid putting extra pressure on the big toe. For hallux rigidus, you might benefit from stiff shoes or a cushion or toe spacer in your shoes.

You might need to limit certain activities, like walking upstairs. Physical therapy may help as well.

Pain Relief Methods

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as Advil (ibuprofen) can often help relieve pain. Talk to a healthcare provider about whether NSAIDs are safe for you.

Heat or ice packs may also help ease the pain.

Periodic corticosteroid injections into the MTP joint may also provide temporary relief in some people, like those with hallux rigidus.

Surgery

Certain kinds of MTP joint pain, like from trauma, may require surgery. Many broken toes can heal with self-care approaches, rest, and a splint. However, if your pain doesn’t seem to improve after other treatment measures, you may want to discuss surgery as an option with your healthcare provider.

Treatment for the Underlying Condition

Big toe joint pain caused by specific underlying illnesses requires additional treatment. Someone with gout may require immediate treatment with NSAIDs and other medications to help prevent future flare-ups. Someone experiencing joint pain from an infection might need antibiotics intravenously (into a vein). 

Pain in the MTP joint can be caused by various conditions, including bunions, osteoarthritis, gout, sesamoiditis, trauma, and infection.

At-home care involving rest and ice is often sufficient. In other cases, shoe modifications, orthotics, pain medications, joint injections, surgery, or other treatments might be necessary.