The two commonest causes for pain in the big toe are Hallux valgus (Bunion) and Hallux rigidus (Osteoarthritis). The two conditions (Bunions and Big Toe Pain) are often confused by patients and doctors alike, and occasionally both may co-exist in the same toe.
In Hallux valgus, the big toe typically drifts outwards towards the smaller toes and a bump appears on the inner aspect of the foot, which becomes red and swollen when it rubs. It is common for bunion problems to run in families. Wearing tight, high-heeled shoes and laxity of joints have also been implicated as causative factors. Most people have no symptoms but some develop pain over the bunion, difficulty with wearing shoes and in severe cases difficulty with walking. Over time, the deformity generally slowly worsens, and pain under the ball of the foot and ‘hammer toe’ deformities of the adjacent toes can develop. Many people with bunion problems can be managed with the use of appropriate footwear and in some cases with the use of orthotics. If these measures fail, patients with continued symptoms, difficulty with wearing shoes and increasing deformities can be helped with appropriate bunion surgery. The purpose of surgery is to correct the deformity, narrow the foot and improve biomechanics (structure and function) of the foot. The particular operative procedure chosen will be discussed in greater detail with you by your surgeon.
Hallux rigidus causes stiffness, pain and swelling of the big toe in the first metatarsophalangeal joint. It is commonly due to osteoarthritis of gradual onset but can also be caused by fractures, by gout or other rarer pathologies. Most people with hallux rigidus suffer from pain and restriction of movement in the big toe. Common complaints are a dull aching pain in the big toe (worse with walking distances), difficulty wearing shoes and decreasing sporting activity. Most patients can be managed with the use of appropriate footwear and reduction in activity levels. Health food medication like Glucosamine or Chondroitin Sulphate and Cod Liver Oil are thought to be beneficial in arthritis but this is not clearly proven. In the early stages steroid injection and manipulation of the joint can produce relief of pain for some time. If conservative measures fail then the situation can be improved by an operation. There are a number of different operative procedures that can be used, depending on the stage of the disease and other factors. These include Cheilectomy (removal of excess bone and cleaning the joint), Arthrodesis (‘Fusion’) of the metatarsophalangeal joint, Replacement arthroplasty (‘Joint replacement’) or Excision arthroplasty (Keller’s joint excision).