Big toe pain is a common problem that can make walking, standing, and wearing shoes uncomfortable.

The big toe plays a vital role in balance and push-off during walking, so even mild pain can quickly start to affect daily activities.

Pain in the big toe joint can appear suddenly or gradually over time. It might be felt on top of the joint, under the toe, along the side, or deep inside the joint itself.

In some cases, big toe joint pain is mild and short-lived, but in others it becomes persistent and progressively worse.

This guide will help you understand the most common causes of big toe pain, typical symptoms, how big toe joint pain is diagnosed, and the best treatment options to relieve pain and prevent long-term problems.

Common Symptoms of Big Toe Pain

Pain in the big toe can present in several different ways depending on the underlying cause. Common symptoms include:

• Pain at the base of the big toe (first MTP joint)
• Stiffness or reduced movement
• Swelling or redness
• Pain when walking or pushing off
• Pain at night or first thing in the morning
• A painful or hard lump near the joint
• Burning, tingling, or shooting pain

Big Toe Pain Patterns & What They Mean

The type of pain you feel often gives important clues about what is causing it.

What Causes Big Toe Pain?

Pain in the big toe may develop due to problems affecting:

• The joint: arthritis, bunions, fractures
• The bones: bone spurs, stress fractures
• Soft tissues: tendons, ligaments, capsules
• Nerves: compression or irritation
• Skin & nails: blisters, infections, ingrown nails

Pain in the big toe joint most commonly affects the first metatarsophalangeal (MTP) joint, the joint at the base of the big toe where it meets the forefoot, which takes a large amount of force with every step.

Let’s have a look at the most common causes of big toe pain in more detail.

2. Bunions (Hallux Valgus)

Bunions are a very common cause of big toe joint pain, forming a lump at the base of the big toe. They occur when the big toe drifts inwards toward the second toe, while the 1st MTP joint pushes outward.

This creates a prominent, often painful lump that may rub against footwear.

Typical Symptoms

• Hard and bony on outer edge of the base of the big toe (1st MTP)
• Red or swollen if irritated by shoes
• Big toe pain when walking or prolonged standing
• Slow-growing, worsening over months or years
• Associated with reduced big toe movement in later stages

Bunions are commonly linked with tight or narrow footwear, genetics, altered foot biomechanics, and arthritis. As the deformity progresses, big toe joint pain often increases and walking can become uncomfortable.

7. Nerve Irritation

Compression or irritation of nerves supplying the big toe can cause shooting, burning, or tingling pain in the big toe.

Typical Symptoms

• Sharp or burning pain
• Tingling or numbness
• Pain that worsens in tight shoes
• Decreased sensation

8. Blisters, Warts & Skin Conditions

Problems affecting the skin can also cause pain in the big toe, including:

• Friction blisters
• Plantar warts
• Fungal or bacterial infections
• Contact dermatitis

These often cause surface tenderness rather than deep joint pain.

How Is Big Toe Pain Diagnosed?

Pain in big toe diagnosis usually starts with a clinical examination, focusing on:

• Big toe joint position and alignment
• Range of motion testing
• Tenderness and swelling
• Walking and weight-bearing assessment

Investigations may include:

• Weight-bearing X-rays: arthritis, fractures, bunions
• MRI or ultrasound: soft tissue or nerve problems
• Blood tests: if gout or infection is suspected

Accurate diagnosis is essential, as many causes of big toe joint pain feel similar.

When to See a Doctor for Big Toe Joint Pain

You should see a doctor or podiatrist if:

• Pain in big toe is severe or worsening
• The joint is red, hot, swollen or very tender
• Pain started suddenly after injury or with no clear cause
• You have difficulty walking
• Symptoms do not improve within 1–2 weeks of home care
• You have gout, diabetes, or circulation problems

Red flags requiring urgent assessment:

• unable to walk
• snap or pop at time of injury
• obvious deformity
• neurological symptoms

Treatment Options for Big Toe Pain

Big toe joint pain treatment depends on the cause of but often includes a combination of the following:

1. Conservative Treatment

• Rest and activity modification
• Footwear with a wide toe box
• Insoles or orthotics to reduce pressure
• Toe spacers or padding
• Ice and elevation for swelling

2. Medications

• Anti-inflammatory medications (NSAIDs)
• Gout-specific medications if required
• Pain relief as advised by your doctor
• Topical treatments for skin conditions

3. Physical Therapy

• Joint mobility exercises
• Strengthening and stretching exercises
• Gait retraining
• Joint mobilisation

4. Injections or Surgery

• Steroid injections for inflammation
• Joint injections for arthritis
• Drainage of cysts or abscesses
• Surgery for severe arthritis, bunions, or deformities

FAQs About Big Toe Pain

Let's have a look at some on the most frequently asked questions about big toe pain.

Big Toe Pain Summary

Big toe pain is a common problem that can significantly affect walking and daily activities. Key points:

• Big toe joint pain is most often caused by hallux rigidus, bunions, or gout
• Pain underneath the big toe is commonly due to sesamoiditis
• Sudden severe pain with redness often indicates gout
• Stiffness usually suggests arthritis
• Shooting pain or altered sensation may be nerve-related

Early diagnosis and treatment helps prevent stiffness, deformity, and long-term pain.

If your pain in the big toe is persistent, worsening, or affecting your mobility, a professional assessment is recommended. If your other toes are affected, check out the toe joint pain article.

You may also be interested in the following articles:

• Lump On Toe
• Sharp Pain Big Toe
• Foot Pain Diagnosis Chart
• Top Of Foot Pain
• Pain On Bottom Of Foot
• Pain On Side Of Foot

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References

1. Bunions: What Else Might It Be. Differential Diagnosis. NICE Guidelines
2. Stiff Big Toe (Hallux Rigidus). Royal College Of Podiatry
3. Painful Big Toe Joint (Hallux Limitus/Rigidus). NHS UK

Page Last Updated: 9th January, 2026
Next Review Due: 9th January, 2028