The most common disorders of the big toe joint are bunions, arthritis and sesamoiditis, the last an overuse injury. The big toe joint or the MTP (metatarsophalangeal) joint is important because it bends with each step, and if it is compromised in any way, walking can become painful and difficult.
Bunions, which can usually be prevented by wearing shoes that fit properly, is a deformity where the base of the MTP joint gets larger and sticks out, with the skin becoming tender. Caused by wearing tight, narrow shoes and high heels, bunions may become too painful to wear any type of shoe and can lead to bursitis, chronic pain and arthritis as well as a grotesquely deformed foot with misaligned and overlapping toes.
Moderate cases may be helped by wearing roomy shoes; however surgery may be indicated if a bunion has progressed to the point where walking is difficult or pain is experienced despite accommodative shoes.
Arthritis in the MTP joint can result in hallux rigidus, a stiff big toe, which can be painful and make walking difficult. Pushing off on the toes is especially problematic, as a stiff toe does not bend (up or down) and causes pain. The pain may force the person to walk on the outside of his or her foot, and other symptoms can include swelling around the joint and a bony bump on top of the foot.
Non-operative treatments such as anti-inflammatory medications, icing and wearing shoes with a rocker bottom, may ease the pain but will not stop the condition from progressing. A variety of surgical approaches are available, the selection depending on the degree of arthritis within the joint. The goals of surgical treatment are pain relief and, whenever possible, retention of joint motion.
A condition seen in dancers and runners is called sesamoiditis, and is an overuse injury. Two very small bones (sesamoids) near the big toe, which interact with the tendons, help with weight bearing and elevating the bones of the big toe, can be fractured, causing pain, swelling and possibly difficulty in moving the big toe.
A form of tendonitis, sesamoiditis usually responds to non-surgical treatment including rest, icing and shoewear modification, as well as a period immobilization if inflammation is present. If conservative measures fail, surgery may be recommended to remove the sesamoid bone.
For more information on these injuries and their treatments please see: