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Causes of Pain at the Big Toe Joint

Also Known as the First Metatarsophalangeal Joint


Updated May 16, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Even though the joints of the toes are small, they are important for healthy foot functioning, and they also endure significant weight-bearing stress. The first metatarsophalangeal joint (1st MTPJ) is the joint that connects the big toe to the first metatarsal bone of the forefoot. Some of the problems that most frequently occur at this joint include:

1. Bunion

A bunion describes a large bump over the big toe joint that is associated with a common foot condition known as hallux valgus. Besides the appearance of a bump, hallux valgus causes a shift in position of the big toe, causing it to drift toward the lesser toes over time. The usual result is a widened forefoot and a red, irritated bump on the side of the big toe joint. While most bunions are due to faulty foot biomechanics, conditions such as rheumatoid arthritis can lead to a bunion deformity.

2. Hallux Limitus

Hallux limitus is a condition that limits joint range of motion at the big toe joint. In order for the feet to efficiently distribute pressure as we walk, a certain degree of flexibility is needed at the big toe joint. When the big toe joint locks up during gait, arthritis can develop in that joint, further limiting range of motion. Hallux limitus may result in a bunion, or a bump on the top side of big toe joint.

3. Arthritis

The most common form of arthritis that affects the big toe joint is osteoarthritis, caused by wear-and-tear—with typical symptoms of joint pain and stiffness. Osteoarthritis at the big toe joint may develop from problems with foot structure and functioning, resulting in excess wear-and-tear. Trauma such as a fracture or dislocation of the big toe can also result in osteoarthritis. Other, less common types of arthritis that affect the big toe include rheumatoid arthritis and psoriatic arthritis.

4. Gout

Gout is a metabolic condition that can affect the big toe joint. Gout occurs when uric acid builds up in the blood, although this does not always cause symptoms. When uric acid forms crystals that deposit into joints—such as the big toe joint—an attack of acute gouty arthritis can occur. Symptoms of gouty arthritis include a red, hot, and intensely painful joint. If gout attacks go untreated and occur repeatedly for a number of years, joint damage may occur.

5. Sesamoiditis

The sesamoid bones are two small bones that sit below the 1st MTPJ within a tendon that flexes the big toe downward. The sesamoid bones are subject to pain and inflammation from acute or chronic trauma. Sesamoiditis is often linked to activities that involve balancing on toes or jumping, such as ballet dancing or basketball. Fracture of a sesamoid bone can cause similar symtoms.

6. Turf Toe

Turf toe is a common sports-related injury, and like sesamoiditis, is characterized by pain on the bottom of the big toe joint. The pain stems from a sprain, which is an injury or tear of a ligament. The name turf toe comes from the link between this injury and sports played on artificial turf, such as football and soccer. The conditions of the hard turf, athletic shoes, and stress on the toe from running may all contribute to this injury.

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