Bunions, Stiff Big Toe, Pain Under The Big Toe

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A bunion is a bulge or bump that develops on the inner side of the foot, near the base of the first toe. It is caused by  poor alignment of the metatarsal-phalangeal joint of the big toe, or hallux. Physicians call this deformity "hallux abducto valgus," or H.A.V. This  term refers to the hallux abducting or going away from the midline of the body. It also refers to a twisting of the toe so that it's inside edge touches the ground and its outside edge turns upward. Essentially, it describes the big toe's tendency to deviate toward the outside of the foot. The condition tends to worsen over time leading to discomfort and skin problems, such as corns and lesions, and eventually difficulty in walking.

bunions photoBunions are among the most common problems of the foot. They tend to run in families, suggesting genetic factors associated with the inherited shape of the foot in certain families. These genetic factors may predispose some people to develop bunions.

Some doctors believe the pronated or flat foot, with its characteristic instability, is a common cause of H.A.V. This is because in walking, the body's weight is repeatedly transferred to the hallux. Normally, this isn't a problem, but in an unstable flat foot, this transfer of weight allows certain muscles to be stronger than others. This overpowering of muscles causes the toe to bend and deform.

Other doctors believe bunions are caused by excessively tight and pointy toe-boxes in shoes, high heels, and shoes that are too small. This premise is supported by the fact that women, whose shoe fashions run toward narrow widths and high heels, tend to get bunions much more often than men do. However, research suggests that such factors as improper shoes don't cause bunions as much as they exacerbate the underlying causative problem of flat, unstable feet.

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The typical bunion starts off as a mild bump or outward bending of the big toe. This is only a cosmetic concern at first. However, beneath the surface, strong forces are at work.

The forces imparted by the misaligned, outward-bending toe stretch the  ligaments that connect the bones of the foot. This in turn pulls against the tendons, gradually drawing the big toe farther out of line. Over time, the hallux will continue to twist away from its original position until it no longer lines up properly with its corresponding metatarsal. The end of the metatarsal may become enlarged. Pressure from the first toe can lead to deformity of the metatarsal-phalangeal joint in the second toe, pushing it toward the third toe. In some cases, the second toe may ride up and over, or down and under, the hallux. At this point, the range of motion in the big toe will decrease, a condition known as Hallux Limitus.

The condition begins to become painful at this stage. Because the bunion has changed the shape of the foot, the biomechanics of walking become altered. Normally, the hallux can bend at least 65 degrees, enabling it to be the last part of the foot to leave the ground during walking. However, with hallux limitus, the big toe cannot perform its function properly, and the weight of the body is transferred almost completely to the bunion. The body tries to compensate for this by changing. Typically, a person with uncomfortable bunions gradually begins walking in an exaggerated toe-turned-out fashion, somewhat like a duck, so the painful hallux does not have to bend so far. This is a vicious cycle, however, as the same forces causing the feet to turn outward steadily force the hallux even farther out. Inevitably this causes the bunion to worsen. Unless something is done to break this cycle, the deformity eventually becomes disabling.

For further advise please contact one of our professional team here  or give us a call, our number is listed on the Contact page.

Stiff Big Toe

The function of the toes, especially the big toe, is to help us balance, and to propel us forward during walking or running. One of the most common complaints is "Hallux Abducto Valgus", better known as a Bunion. American research has indicated that Women suffer from bunion deformities 4 to 6 times more frequently than men. However, a complaint that can also cause pain at the big toe joint which, according to research, is actually more common among men then women, is Hallux Rigidus.

What is Hallux Rigidus? (“Stiff Big Toe”)

Hallux Rigidus, “stiff big toe,” is a commonly occurring condition of degenerative arthritis (a wearing out of surfaces) affecting the big toe joint. The condition results over time from constant wear and stress or from an injury to the joint. The result of the condition is pain, swelling, and/or restriction of movement; eventually the sufferer will stop bending the joint when transferring weight to the other foot, as in walking or running. Women will probably have to stop wearing shoes with high heels.

Causes of Hallux Rigidus?

In most cases, there is no definite cause of this condition. Because of the tremendous stress put on this small joint over time (a force equal to twice one’s body weight), eventually the joint simply begins to wear out. It can affect fairly young people, even as young as teenagers.
Hallux Rigidus can also result from an injury or as a complication of another medical condition, such as Gout or infection. It can also result from mechanical or anatomical problems in the foot and ankle, excessive Pronation (rolling in) of the ankles, as well as toe deformities, which increase the stress on the joint.

Symptoms of Hallux Rigidus?

Two problems result from Hallux Rigidus: pain and stiffness (loss of motion). Walking is painful and difficult, since the MTP joint cannot move enough to allow the foot to “roll through” while walking.

Treatment of Hallux Rigidus?

As a form of degenerative arthritis, treatment begins with anti-inflammatory medication. Other conservative treatments include:

  • Special shoes that reduce the amount of bend in the toe while walking or thick-soled shoes
  • Shoes with a larger toe box
  • Stretching of the foot
  • Avoid high heels
  • Watch your weight

When conservative treatments fail, surgery may be required. As with Bunion deformities, there are several types of surgical procedures available to treat Hallux Rigidus, depending on the severity of the case.
So, if you suffer from a painful big toe joint, you don’t have to put up with it, please phone (07 579 0090) or Contact us, to make an appointment with Stefan who will be happy to talk to you about the best treatment option, for you.

Pain Under The Big Toe

Most bones in the human body are connected to each other at joints. But there are a few bones that are not connected to any other bone. Instead, they are connected only to tendons or are embedded in muscle. These are called the Sesamoids. The kneecap (patella) is the largest Sesamoid. Two other very small Sesamoids (about the size of a kernel of corn) are found in the underside of the forefoot near the great toe, one on the outer side of the foot and the other closer to the middle of the foot. Sesamoids act like pulleys. They provide a smooth surface over which the tendons slide, thus increasing the ability of the tendons to transmit muscle forces. The Sesamoids in the forefoot also assist with weight bearing and help elevate the bones of the big toe. Like other bones, the Sesamoids underneath the big toe can break (fracture). Additionally, the tendons surrounding the Sesamoids can become irritated or inflamed. This is called Sesamoiditis and is a form of Tendinitis. It is common among runners, cyclists and squash players.

Signs and symptoms:

  • Pain is focused under the big toe on the ball of the foot.
  • With Sesamoiditis, pain may develop gradually.
  • With a fracture, pain will be immediate.
  • Swelling and bruising may or may not be present.
  • You may experience difficulty and pain in bending and straightening the big toe.


  • Stop the activity causing the pain.
  • Return to activity gradually, and avoid activities that put your weight on the balls of the feet.
  • Cushioning pads can be helpful as the fracture heals.

Treatment is generally non-operative. However, if conservative measures fail, Stefan may recommend surgery.