Toe arthritis

Pain around the big toe can come from osteoarthritis, a bunion, gout, an earlier injury or irritation of the tendons and small sesamoid bones beneath the joint. The location of the pain, how quickly it developed and whether the toe is swollen, stiff or misshapen can help identify the likely cause.

Common symptoms include pain at the base of the big toe, stiffness, swelling and difficulty bending the toe upwards. You may also notice a hard bump on top of the joint, discomfort in shoes or pain when walking, running or pushing away from the ground.

Hallux limitus describes restricted movement at the base of the big toe. Hallux rigidus is generally used when arthritis and stiffness have become more advanced and movement is severely limited. These terms describe a range of change, but symptoms and progression can differ considerably between individuals.

Big toe arthritis usually develops gradually and causes stiffness and pain during movement. A bunion changes the position of the toe and creates a prominent bump on the inside of the foot. Gout often causes sudden, intense pain with marked redness, heat and swelling. These conditions can sometimes occur together, so assessment may be needed.

A clinician will usually examine the movement, position and tenderness of the toe and assess how you walk. A standing X-ray can show joint-space narrowing, bone spurs and changes in alignment while the foot is carrying weight. Ultrasound or other scans may occasionally be used when the source of pain remains unclear.

There is currently no treatment that restores established cartilage loss. However, pain and function can often be improved through suitable footwear, pressure reduction, activity changes, exercise, orthoses and appropriate clinical treatment. The condition does not progress at the same rate in everyone.

Shoes with a wide and sufficiently deep toe box can reduce rubbing around the joint. A firm or rocker-shaped sole may reduce how far the painful toe needs to bend during walking. High heels and very flexible footwear can increase pressure through the front of the foot and may aggravate symptoms.

Remaining active is usually helpful, but activities may need to be adjusted. Cycling, swimming and other lower-impact exercise may place less pressure through the toe. Mobility work should remain comfortable, as repeatedly forcing a severely restricted joint can increase irritation.

Insoles, carbon-fibre plates and other orthoses may reduce painful movement or redistribute pressure away from the big toe joint. Their usefulness depends on your foot shape, footwear and walking pattern. Assessment by a podiatrist can help determine which type of support is most appropriate.

An injection may be considered when pain continues despite footwear changes and other simpler treatments. Corticosteroid aims to reduce inflammation, while hyaluronic acid is offered in some settings with the aim of improving the lubricating properties of the joint fluid. Benefits vary, and injections do not reverse arthritis or restore lost cartilage.

The response differs between individuals and depends on the cause and stage of the problem. Some people experience little change, while others gain relief for weeks or months. A clinician should explain the expected benefits, possible risks and what to do if the injection does not help.

Surgery may be considered when pain and stiffness continue to restrict walking or footwear despite non-surgical treatment. In selected cases, a cheilectomy can remove bone that is blocking movement. For more advanced arthritis, fusion of the joint may offer reliable pain relief, although it permanently removes movement from that joint.

Seek prompt medical advice if the toe becomes suddenly very painful, hot, red or markedly swollen, particularly if you also feel unwell or have a fever. Significant injury, an open wound, changing skin colour, loss of sensation or an inability to bear weight should also be assessed promptly.