If you have pain in the big toe joint you are likely experiencing one of three related conditions:

  1. Hallux Limitus (Pain in the big toe joint due to too much pressure)
  2. Hallux Rigidus (Arthritis in the big toe joint)
  3. Bunions (Enlargement of the big toe joint)

On this page you will learn about bunions. You can use the links to learn more about hallux limitus and hallux rigidus. All of these problems can be usually be treated non-surgically, but if not treated will get worse over time. If you are experiencing any pain in the big toe joint or can see changes in that joint you should call today for an appointment to see us in our Seattle foot and ankle clinic. If you are experiencing any pain in the big toe joint or can see changes in that joint you should call today for an appointment to see us in our Seattle office.

The Cause of Big Toe Pain and Bunions

When humans walk, during the last part of a step, just before the foot comes off the ground, the big toe joint should bend up about 75 degrees. If this natural motion is not allowed, pain and deformity can develop.

Some people have a foot that rolls inward – or “over-pronates” – too much as they walk. When the foot over-pronates, the big toe joint is pushed into the ground. This prevents the big toe joint from bending naturally during the step.

bunions

Figure 1: Foot rolling inwards

Treatment Goals: Relieve Pain and Avoid Further Damage to your Joint

If you are experiencing bunions or big toe joint pain, you should make an appointment to see us as soon as possible. Left untreated, these problems only get worse – bunions get bigger or the joint develops arthritis. But we can usually eliminate your pain and protect your joint without having to do surgery. Hallux Limitus and bunion treatment varies depending on your foot type, severity of the deformity, your activities and your symptoms. Evaluation should be sought at the first sign of a bunion condition, so severe deformity and arthritic changes can be avoided.

Early Treatment Helps Prevent Future Problems

The primary purpose of early treatment is to relieve pressure within the big toe joint and to diminish the progression of joint damage. The main conservative therapies include:

  • Custom foot orthotics for bunions and big toe joint pain; prescribed and cast by your doctor and designed to relieve pressure within the big toe joint
  • Shoe Therapy; including proper shoes for your foot type and activities and possible modifications to your shoes
  • Accommodative Padding

Custom Orthotics Can Relieve Big Toe Problems

bunions pressure map

Figure 2: Pressure map shows big toe joint twisted and pushed out on the side of the foot. Highest pressure is around bunion area and so has the potential to get worse.

Custom functional orthotics are useful in controlling abnormal foot mechanics and preventing the need for surgery.

Orthotics for big toe joint problems are prescribed specifically to help decompress the big toe joint and help it work in a way that decreases the chance of joint damage. In order to ensure best outcomes we first perform a detailed examination, including slow motion video analysis, of how you walk and how your big toe joint works. A mold of your foot is then taken in a very specific position and the orthotic devices are prescribed in a manner to best protect the joints.

In order to best improve function of your big toe joints, research has shown that orthotics must be made from non-weightbearing casts of your feet with the foot held in the position that provides the best function of the big toe joint.

Also, studies have indicated that a very specific type of foot orthotic does the best job at helping the big toe joint work as it should. These are Total Contact Foot Orthotics – orthotics that conform extremely close to the arch of your foot

Hallux Limitus and bunions are progressive deformities and will get worse over time if not treated correctly. The correct orthotic can help decrease pain and possibly prevent progression.

What Causes Pain in the Big Toe Joint?

When the big toe cannot bend upward, excessive force builds up inside the joint each time that you take a step. This joint “jamming” can cause pain in the joint and over time lead joint damage such as arthritis. This pain and damage is called Hallux Limitus.

People with Hallux Limitus will have pain in the joint when they walk and sometimes after activity. It can be worse in some shoes than in others. There may or may not be visible signs of changes to the joint and a bunion may or may not be present.

Pain in the big toe joint, even if there is no visible sign of change, is an indication that there is damage occurring to the joint. This warning sign should not be ignored. Hallux Limitus is a progressive deformity and early treatment can help prevent future problems.

What is a Bunion?

In some feet with Hallux Limitus, the first toe starts to move toward the second toe as a means of relieving the excessive force within the joint. This causes an angulation of the toe to the metatarsal bone and the appearance of a bump on the big toe joint. This combination of angulation of the toes and the bump on the outside of the joint is what is commonly known as a bunion deformity. The deformity is also known as Hallux Abducto Valgus or HAV.

The deformity does run in families; however, the foot type is hereditary, not the bunion. Shoes do not usually cause bunions, although the wrong shoes can make the deformity more painful.
HAV is a progressive deformity. Treatment can slow or stop the progression in many cases and help prevent joint damage or the need for surgery.

When is Bunion or Big Toe Joint Surgery Needed?

For Information on Bunion Surgery Click here.

When you start to have joint pain or the bunion condition limits your activities and all conservative options have failed, surgery may be necessary. Joint pain may indicate degeneration of the joint cartilage. One of the goals in surgery is to realign the joint to prevent further loss of joint cartilage.

Pain and deformity are significantly reduced in the great majority of patients who undergo bunion surgery. Bunion surgery allows for realignment of the joint. After surgery the foot should be able to carry the body’s weight in a more normal fashion and special shoes should no longer be required. Postoperative orthoses may be recommended to improve foot function and limit excessive forces through the great toe joint.

Don’t let your bunions or big toe pain get worse. Early treatment can prevent future problems. Call today for an appointment in our Seattle office.

Don’t let your bunions or big toe pain get worse. Early treatment can prevent future problems. Call today for an appointment in our Seattle office.

 

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