big toe pain arthritis causes

What’s Aching Your Big Toe?

It is easy to forget how important your big toe is – most of the time it stays out of sight and out of mind, hidden beneath our socks and shoes. But if you have ever had toe pain, you know it can keep you off your feet and up at night.

When arthritis affects the foot it usually hits at the base of the big toe in what is known as the MTP, or metatarsophalangeal joint. This can cause big problems for the tiny joint that has to bend and bear about 50% of your body weight every time you take a step.

Here are six common culprits of big toe joint pain—many of which are related—and ways you can find relief.

Osteoarthritis (OA)

The big toe joint is a common site for this “wear and tear” form of arthritis. Symptoms of toe OA include pain, swelling, and stiffness, particularly first thing in the morning.

Rheumatoid Arthritis (RA)

This autoimmune disorder, which affects the lining of the joints and causes painful inflammation, often starts in the hands and feet. When RA damages the tissues, it can cause the toes to curl downward leading to deformities like claw toe or hammertoe.

Hallux rigidus

Hallux rigidus, which means “stiff big toe,” affects nearly one in every 40 people over the age of 50. Over time, your toe can become so painful and stiff that it freezes up, making it difficult to bend and walk. Hallux rigidus typically develops from OA, RA, overuse, or injury.


If the base of your big toe is enlarged and painful, you probably have a bunion, also known as hallux valgus. Your big toe may move toward or under your second toe as the joint gets further out of alignment. Wearing tight-fitting shoes can cause bunions or make existing ones worse.

Bone spurs

A bone spur is a tiny, pointy overgrowth that sticks out at the end of the bone. When your cartilage breaks down, from OA or injury, the bones rub together. The body tries to repair the damage by adding an extra piece of bone. Pain and numbness can occur, but bone spurs do not always cause symptoms. If the bone spur prevents the big toe from bending properly, hallux rigidus may develop.


Gout is an inflammatory form of arthritis that occurs when high levels of uric acid crystals build up in the joints. The big toe is commonly affected, but gout can also appear in the elbow, knee, wrist, or ankle. Gout attacks can be so sudden and severe that people often wake up in the middle of the night and rush to the hospital. Medications that lower the level of uric acid in the body can prevent future attacks. Genetics, obesity, and using diuretics are risk factors for developing gout.

Three Ways to Treat Big Toe Pain

Big toe pain caused by RA or gout should be treated by a rheumatologist. A podiatrist can help you find treatments for foot pain resulting from a variety of other causes.

  • Shoes: Wear supportive shoes with thick soles and a wide toe box that takes pressure off the big toe. Ditch your high heels. Use arch supports or orthotics. Pad bunions, corns, and calluses to prevent rubbing.
  • Pain killers: Take over-the-counter pain relievers like acetaminophen (Tylenol) and anti-inflammatory medications such as ibuprofen (Advil). Your physician may suggest prescription nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Ice: Apply a cold pack for 20 minutes to relieve pain and reduce swelling. Warm footbaths can also soothe achy joints.

If conservative options fail, your doctor may recommend a corticosteroid that is injected directly into the joint to reduce inflammation. Surgical alternatives may also be considered.

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