# Big toe pain > Big toe pain is pain in or around the big toe joint. Common causes are arthritis of the joint, gout, bunions and irritation of the small bones under the toe. Roomier shoes, adjusting activity and simple pain relief are the usual first steps, and a podiatrist can help find the cause. Guide in [Toes and forefoot](https://footanklelowerlimb.com.au/learn/topics/toes-and-forefoot), from Foot Ankle Lower Limb: https://footanklelowerlimb.com.au/learn/big-toe-pain Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod (Podiatrist) on 27 October 2026. Next review by 27 October 2027. - **Big toe pain has several causes,** most often arthritis of the big toe joint, gout, a bunion or irritation of the small bones under the joint. - **How it started is a useful clue:** sudden pain with a hot, red, swollen joint can point to gout, while slow stiffening can point to arthritis. - **Self-care comes first:** roomier shoes with a low heel, adjusting activity and simple pain relief are the usual first steps. - **Some signs need prompt care,** such as a hot, swollen joint with a fever, or any sore or colour change on the foot if you have diabetes. ## What is big toe pain, and how common is it? Big toe pain is pain in or around the big toe joint. It's commonly linked to arthritis or wear and tear [1]. Bunions and gout are other common causes. Foot pain is common in middle and older age, more so in women, and the toes and forefoot are the most common places for it [2]. Arthritis of the big toe joint affects about 7.8% of people aged 50 or over, and 72% of people with it say it's disabling [3]. A bunion (hallux valgus) is the most common foot deformity [4]. ## What can cause big toe pain? A few conditions account for most cases, and the way the pain behaves can help tell them apart: - **Hallux rigidus (arthritis of the big toe joint).** The joint slowly loses movement over time [5]. - **Gout.** Sudden severe pain, usually in the big toe, with hot, swollen, red skin over the joint [6]. The pain builds over hours, and gout is more common in older men [1]. Redness can be harder to see on black or brown skin [6]. - **A bunion.** The joint changes shape and can become sore, especially in shoes that squeeze it [4]. - **Sesamoiditis (irritation of the small bones under the joint).** Pain under the joint or across the underside of the toe, often worse with movement and walking or standing [7]. An injury is also a common cause of a painful, swollen joint [8]. Less often, bursitis, a stress fracture or an infection can be behind forefoot pain [9]. ## How is the cause found? A podiatrist will ask how the pain began, how long you've had it, how bad it is, whether there's swelling, what you can no longer do, and whether the shape of your toe has changed [9]. They'll then check how well the joint moves, where it's tender, muscle strength and calf tightness [9]. Tests are used only when needed. No single sign proves gout, and pain in the big toe joint on its own isn't a reliable clue [10]. The definite test is finding urate crystals in a sample of joint fluid [11]. A doctor may also take a sample to rule out infection [12], and an ultrasound or a special CT scan can help [12]. Sesamoid problems are mainly diagnosed by examination. A weight-bearing X-ray is used if surgery is being considered, and an MRI if there's doubt [13]. > [!tip] Try this > Before your appointment, jot down which joint hurts, how quickly the pain came on, and whether the toe is red, hot or swollen. It helps your podiatrist or GP tell the common causes apart. ## What helps first? Non-surgical care is the usual first step for bunions and big toe arthritis [14][3]. Things to try: - **Roomier shoes.** Look for a wider, deeper toe box, a low heel and a firm rocker sole (a curved sole that helps your foot roll forward) [9]. Avoid heels [1]. - **Adjust your activity** to what your toe will tolerate [9]. - **Simple pain relief or ice.** A pharmacist can advise on over-the-counter options [1]. - **Weight management** where it applies, as being overweight may worsen symptoms [1]. - **Bunion pads or simple over-the-counter insoles** may help in the short term [1]. Shoe inserts made for big toe arthritis (arch-contouring orthoses and shoe-stiffening inserts) haven't shown a clear benefit over fake inserts [3]. Orthotics haven't been shown to slow a bunion getting worse [15]. For gout, an attack is usually treated with an anti-inflammatory medicine such as ibuprofen, with steroids added if pain and swelling don't improve [6]. Get treatment as soon as you feel an attack starting [16]. If you're pregnant, ask your doctor before taking any gout medicine [17]. ## What helps if that isn't enough? If you've given first-line care a fair go and your toe still hurts, it's worth having the cause reviewed. An injection of hyaluronic acid into the joint hasn't shown a clear benefit for big toe arthritis [3]. Surgery may be considered for a bunion that's painful or keeps breaking the skin [13], and for sesamoid pain that hasn't settled with non-surgical care and a steroid injection [13]. It should follow full conservative care and a talk about risks and benefits with the surgeon. While you wait, it helps to keep diabetes, circulation and weight well managed [1]. If gout flares keep coming back or usual treatment isn't working, see your GP [6]. ## Will it get better, and can I stop it coming back? It depends on the cause. With gout, repeated attacks that aren't treated can damage joints and cause tophi (hard lumps under the skin) [6]. Treating attacks early matters [16]. How big toe arthritis and bunions change over time isn't clear yet. For prevention, the most consistent advice is footwear with a wide, deep toe box, a low heel and a rocker sole, plus weight management where it applies [9][1]. These steps can ease strain on the toe, but they can't promise it won't return. ## When to see a podiatrist Go to the nearest emergency department if your big toe joint is suddenly hot, swollen and very painful and getting worse, and you also have a very high temperature or feel hot and shivery, or you feel sick or can't eat. These can be signs of infection inside the joint [6][8]. See your GP or a podiatrist the same day if: - the joint is hot, red, swollen and severely painful, or you can't move it or put weight on it [8]; - you have redness, warmth or swelling that could mean an infection [18]; - you have a sore that isn't healing, skin that has turned dark blue or black, or a foot that has changed shape or is very swollen [18]; - you have diabetes and notice a wound, sore, blister or colour change on your foot [18]. For urgent advice when it isn't an emergency, call healthdirect on 1800 022 222 (24 hours a day), or go to a Medicare Urgent Care Clinic. See your GP soon if you have joint pain and swelling after an injury, or sudden pain, swelling, warmth or redness after recent surgery [8]. See a podiatrist or your GP if: - you have gout symptoms for the first time, or your usual gout treatment isn't helping [6]; - your pain doesn't improve in the first few days, is getting worse, or is still a problem after two weeks of self-care [18]; - you have diabetes, or take steroids, biologics or other medicines that affect your immune system, and have any foot pain [18]. ## Common questions ### How do I know if my big toe pain is gout? Gout often comes on suddenly over hours, with severe pain and a hot, red, swollen joint. But no single sign proves it, and other conditions can look similar. A sample of joint fluid is the definite test. If it's your first episode, see your GP rather than guessing. ### Do bunions always need surgery? No. Non-surgical care comes first: roomier shoes, bunion pads and activity changes. Surgery is usually considered only when a bunion stays painful or keeps causing skin breakdown despite that care, and it should follow a full discussion of risks and benefits with the surgeon. ### Why does my big toe hurt when I walk? Pain that builds with walking or standing is often linked to arthritis of the big toe joint, a bunion, or irritation of the small bones under the joint. A podiatrist can check how the joint moves and where it's tender to work out which one it is. ## Further reading - [Big toe pain on Clindice](https://clindice.com/big-toe-pain) - [Arthritis of the First Toe Joint](https://msk-bexley.nhs.uk/conditions/foot-and-ankle-pain/arthritis-of-the-first-toe-joint), NHS - [Bunions: MedlinePlus Medical Encyclopedia](https://medlineplus.gov/ency/article/001231.htm), MedlinePlus - [Gout](https://www.nhs.uk/conditions/gout/), NHS - [Big Toe Joint Pain :: North Cumbria Integrated Care](https://www.ncic.nhs.uk/services/podiatry/big-toe-joint-pain), NHS - [East Sussex MSK Community Partnership](https://eastsussexmsk.nhs.uk/wp-content/uploads/2025/10/Foot-Ankle-Triage-Guidance-2025.pdf), NHS ## Sources 1. Foot and Ankle Pain Pathway (Age 16+) · NHS. https://www.dgft.nhs.uk/wp-content/uploads/2026/10/Foot-and-Ankle-Pain-v1.8.pdf 2. The population prevalence of foot and ankle pain in middle and old age: a systematic review · Thomas MJ, Roddy E, Zhang W et al. · Pain · 2011. https://doi.org/10.1016/j.pain.2011.09.019 3. Non-surgical interventions for treating osteoarthritis of the big toe joint · Munteanu SE, Buldt A, Lithgow MJ et al. · The Cochrane Database of Systematic Reviews · 2024. https://doi.org/10.1002/14651858.cd007809.pub3 4. Research progress in the etiology and minimally invasive therapy of hallux valgus · Zhu Y, Gao M, Tan H et al. · The Surgeon · 2025. https://doi.org/10.1016/j.surge.2025.01.005 5. Big Toe Joint Pain · NHS. https://www.ncic.nhs.uk/services/podiatry/big-toe-joint-pain 6. Gout · NHS · 2026. https://www.nhs.uk/conditions/gout/ 7. Conservative Treatment of Sesamoiditis: A Systematic Literature Review with Individual-Level Pooled Data Analysis · Biz C, Maccarone MC, Bonso V et al. · Medicina (Kaunas, Lithuania) · 2025. https://doi.org/10.3390/medicina61071215 8. A warm, swollen painful joint (monoarthritis) · NHS. https://yourhealth.leicestershospitals.nhs.uk/library/emergency-specialist-medicine/emergency-department/4456-a-warm-swollen-painful-joint-monoarthritis/file 9. Forefoot pathologies · NHS. https://www.rightdecisions.scot.nhs.uk/refhelp-nhs-ayrshire-and-arran/orthopaedicsmsk/foot-and-ankle/forefoot-pathologies/ 10. Diagnostic value of clinical, laboratory, and imaging findings in patients with a clinical suspicion of gout: a systematic literature review · Sivera F, Andrès M, Falzon L et al. · The Journal of Rheumatology · 2014. https://doi.org/10.3899/jrheum.140456 11. 2018 updated European League Against Rheumatism evidence-based recommendations for the diagnosis of gout · Richette P, Doherty M, Pascual E et al. · Annals of the Rheumatic Diseases · 2020. https://doi.org/10.1136/annrheumdis-2019-215315 12. 2023 EULAR recommendations on imaging in diagnosis and management of crystal-induced arthropathies in clinical practice · Mandl P, D'Agostino MA, Navarro-Compán V et al. · Annals of the Rheumatic Diseases · 2024. https://doi.org/10.1136/ard-2023-224771 13. Foot & Ankle · NHS. https://nhsdorset.nhs.uk/Downloads/aboutus/finance/04_MSKT_0007%20MSK%20Interface%20Service/04_MSKT_0007%20Foot%20+%20Ankle%20Treatment%20Guidance.pdf 14. Surgical interventions for treating hallux valgus and bunions · Dias CGp, Godoy-Santos AL, Ferrari J et al. · The Cochrane Database of Systematic Reviews · 2024. https://doi.org/10.1002/14651858.cd013726.pub2 15. Orthoses Effect on Radiographic Measurements of Hallux Abducto Valgus: A Systematic Review · DeHeer PA, Patel NA, Wolfe W et al. · Journal of the American Podiatric Medical Association · 2024. https://doi.org/10.7547/23-171 16. Pain in your big toe - gout · Bradford District Care NHS Foundation Trust · 2026. https://www.bdct.nhs.uk/pain-in-your-big-toe-gout/ 17. 2024 Update of Chinese Guidelines for Diagnosis and Treatment of Hyperuricemia and Gout Part I: Recommendations for General Patients · Sun M, Lyu Z, Wang C et al. · International Journal of Rheumatic Diseases · 2025. https://doi.org/10.1111/1756-185x.70375 18. Foot and ankle pain information booklet · NHS. https://www.rightdecisions.scot.nhs.uk/media/3egbm4sd/foot-pain-information-booklet-may2021.pdf --- This page is general information, not a diagnosis or a treatment plan for you. For advice about your own feet or legs, see a podiatrist or your doctor. In an emergency, call 000.