Big toe joint pain causes misery and disability

Never underestimate the power of a little joint to cause big problems. But that’s what can happen to senior citizens suffering from big toe joint pain — often as a result of arthritis — which can not only sour the mood and lessen quality of life, but raises the risk of falling and in many cases proves disabling, according to Alan Berman, DPM, of Somers (N.Y.) Orthopaedic Surgery & Sports Medicine Group, PLLC (

Most people associate arthritis with the “big” joints such as the knees and hips. But arthritis, which afflicts an estimated 46 million adults in the United States and 50% of those over age 65, comes in many forms, two of which are specific to the big toe joint and are hardly rare. In a 2009 study in the Journal of Foot and Ankle Research, about 16% of people reporting symptoms of disabling foot pain identified the big or “great” toe as the source of their woes.

“It’s truly remarkable how much misery can result from big toe joint pain,” explains Dr. Berman, who specializes in podiatry and also performs podiatric surgery. “Many patients don’t like to complain and think they can outwait the problem, but seeking professional advice and treatment is the right approach. There’s simply no need to suffer in silence.”

Two types of arthritis

No matter what type of arthritis you have, the condition generally includes ongoing joint pain, swelling, stiffness, tenderness, and problems using the joint. But two types of arthritis specifically affect the big toe: gout and hallux rigidus, or rigid big toe.

Gout is an inflammatory form of arthritis, typically affecting older men and resulting from the deposition of uric acid crystals in the joints (but usually targeting the big toe). Acute gout typically shows up as an intensely hot, red and swollen big toe causing excruciating pain. Risk factors for developing gout include:

  • Drinking alcohol (beer and liquor more than wine);
  • Eating a diet rich in meat and seafood;
  • Being overweight or obese;
  • Having high blood pressure.

Hallux rigidus, or rigid big toe, results from “normal” osteoarthritis — or joint wear-and-tear — affecting the base of the big toe and is the most common site of arthritis in the foot. Symptoms specific to hallux rigidus include:

  • Pain in the joint when you’re active, especially when pushing off on toes as you walk;
  • Swelling around the joint;
  • A bump (caused by bone spurs) that develops on the top of the foot;
  • Stiffness in the big toe and the inability to bend it up or down;
  • An inclination to walk on the outside of your foot to avoid bending the big toe.

Most people suffering from gout are in such distress they’re compelled to seek medical help. But Dr. Berman says that hallux rigidus, which may provoke a less-insistent response, is just as important to treat quickly since the bone spurs that eventually form are evidence of advanced disease and are tougher to eradicate.

“If you wait until you see a bony bump on the top of your foot, x-rays will be required to show the location and size of those spurs, which may require surgery to remove,” he says.

Many treatment options

For gout, the drug colchicine is typically prescribed, both to treat flares and prevent future ones. Diet and lifestyle measures such as weight loss, avoiding alcohol, and eating less meat and seafood are also helpful. For hallux rigidus, surgery is sometimes recommended to remove bone spurs, fuse bones together in the big toe joint or even replace the joint.

But both gout and hallux rigidus share some common home treatments that can be effective for each. They include:

  • Taking anti-inflammatory medications such as ibuprofen;
  • Using ice packs;
  • Using contrast baths, which alternates immersion of the affected foot in cold water for 30 seconds with equal time in hot water for a total of 5 minutes, three times per day;
  • Wearing shoes with a large toe box to avoid pressure on the big toe;
  • Avoiding high-heeled shoes.

“Never think, ‘Oh, it’s just my toe,’” Dr. Berman says. “When pain in your big toe joint starts becoming a real nuisance, it’s time to take action. Speak up and start living your life without pain again.”