Question: 

I’ve been having aches in my right big toe for a couple of weeks, and I’m wondering if it’s time to see a doctor. What could be causing this?

Answered by Alexander Sawatzke, MD, orthopaedic surgeon:

Big toe pain is something I see often in my practice. The most common causes are arthritis, bunions and gout. 

Arthritis of the big toe

Arthritis at the main knuckle of your big toe (called the metatarsophalangeal joint) is one of the most common diagnoses of big toe pain.

With arthritis, the toe often becomes painful and stiff. You might notice some pinching on the top of the knuckle, and bending the toe can be painful.  

Sometimes people have had an injury to that toe in the past, which can lead to arthritis developing later.

Bunions

A bunion is another common cause of big toe pain and comes with a visible deformity. You’ll see a big bump on the inside of your foot where the big toe meets the foot. 

Bunions are most common in females and older individuals. They’re caused by a mix of genetics and environmental factors, like:

• A family history of bunions.
• Collapsed arches.
• Mobility of the midfoot.
• Tight calf muscles.

While tight, pointed, or high-heeled shoes don’t cause bunions by themselves, switching to a better-fitting, wide-toe box will help keep symptoms from getting worse.

Gout

Gout often shows up in people who have other medical conditions, such as diabetes and heart or vascular disease. It’s also associated with alcohol and red meat. 

Gout presents as severe pain with a big, swollen, red toe that develops with no real trauma. The treatment is usually medication from your primary care doctor.

When to see a doctor

Seek medical care if:

• You have a red, swollen toe with no clear reason for it. This could be gout or an infection, which need prompt treatment.
• Your toe pain is not going away, is getting worse or interferes with your daily life.
• You’ve had a recent injury and it hurts significantly to put weight on the foot.

What to try at home first

Before coming in, there are a few things you can try:

• Ibuprofen and Tylenol (if your primary care doctor is okay with these medications).
• Shoes with a wide toe box and stiff sole, such as running shoes with a rocker bottom that you can’t just bend in half.
• Carbon fiber inserts that slide into the bottom of your shoe to stop your toe from bending.
• Stretching out your big toe and your calf muscle.
• Working on keeping the muscles in your foot strong.

Treatment options

As a foot and ankle specialist, I usually get x-rays to see how much arthritis you have or if there’s a bunion. The treatment depends on what’s causing your pain.

For arthritis, if it’s consistently bothering you, there are surgical options available:

• For earlier-stage arthritis, we offer a procedure called a cheilectomy, where we shave some bone off the top where it’s impinging.
• For later-stage arthritis, a fusion of the great toe works well and has been around for a long time. There are also some replacement options, although they don’t perform better than fusion and have higher reoperation and complication rates.

The bottom line

Big toe pain that lasts more than a few weeks deserves attention. Try some home treatments first, but if your pain isn’t improving or it’s interfering with your activities, reach out to your doctor.