My big toe is stiff and swollen. Is it a bunion?
Jason Lake, MD, is an orthopedic surgeon on the medical staff at Banner Gateway Medical Center in Gilbert. He can be reached at (480) 964-2908.
Question: My big toe is stiff and swollen at the base. Is this a bunion?
Answer: Many things can cause stiffness, swelling, and pain at the base of the big toe. Two common causes are gout and arthritis. Bunions typically cause the appearance of a bump on the inner portion of the base of the toe, but stiffness and swelling are less common with bunions.
Gout often presents rapidly and may lead to swelling, redness, and warmth. It may be seen in other joints as well, though the big toe is affected about half of the time. It can be easily confused with infection. Gout is caused by crystallization of uric acid in the joint. It is usually treated with ice and medications. Occasionally, joint fluid is sampled to confirm the diagnosis or rule out infection.
Arthritis of the big toe, or hallux rigidus, is usually a slower onset and may or may not be related to an injury. In a normal joint the ends of the bones are covered in smooth cartilage that allow painless motion. In arthritis, the cartilage becomes damaged leading to painful motion.
Bone spurs may form that limit motion of the toe. It is diagnosed with a good history and physical exam combined with an X-ray. Early treatment is with medications, icing, shoe modifications, and occasional injections. Surgical treatment is reserved for moderate or severe conditions that fail conservative measures. This may include spur removal, fusion (making the two bones grow together), or very rarely a replacement.
Evaluation by a physician is important to confirm the diagnosis and initiate treatment.