Big toe pain can bring your daily routine to a grinding halt. Whether it’s a dull ache when you walk or a sudden, throbbing pain that wakes you up at night, it’s not something to ignore. But what exactly is causing it? Two common culprits are hallux rigidus (sometimes called a stiff big toe or hallux limitus) and gout. While these conditions affect the same area of the foot, they’re very different in how they develop and how they’re treated.
In this article, we’ll walk you through what each condition is, how to tell them apart and what your options are for relief.
What Is Hallux Rigidus?
Hallux rigidus is a form of degenerative arthritis that affects the joint at the base of your big toe. Over time, the cartilage in this joint breaks down, causing pain, stiffness and swelling - especially when you’re walking, climbing stairs or bending the toe.
This condition is common in adults over 30 and can slowly worsen with age.
“Hallux rigidus is basically arthritis in the big toe joint. It often starts as soreness during activity and gradually leads to reduced motion of the joint,” explains Jeffrey Levy, D.O., fellowship-trained foot and ankle orthopedic surgeon at Riverside Orthopedic and Sports Medicine Specialists.
What Is Gout in the Big Toe?
Gout is a type of inflammatory arthritis caused by a buildup of uric acid crystals in the joints. While gout can affect any joint, it often starts in the big toe, usually as a sudden and intense flare. A gout flare can happen suddenly, often overnight, causing the toe to become red, hot, swollen and extremely tender.
“Gout flares often occur in men over 40 or in people with diets high in purines, like red meat and alcohol, shellfish, and certain medications” explains Roya Sedghi, M.D., a board-certified internal medicine physician at Riverside Internal Medicine Williamsburg.
Comparing Gout vs. Hallux Rigidus Symptoms
It’s easy to confuse these two conditions because they both affect the big toe, but while both conditions affect the same joint, their symptoms typically feel very different.
With hallux rigidus, the pain tends to come on slowly, starting primarily in the big toe joint. You might notice it gets worse with activity and improves with rest. The joint may feel stiff or difficult to move, and you might see a bump forming on top of the toe. There might also be mild to moderate swelling, and bone spurs may develop over time.
Gout, on the other hand, usually strikes suddenly and with intense pain, swelling and heat. The area around the joint may look stretched or swollen, and even something as light as a bedsheet touching it can cause intense discomfort. Pain typically improves after a few days but may flare up again.
If your symptoms come and go, or get worse with certain foods or drinks, gout may be the cause. If your pain is more related to walking or wearing certain shoes, hallux rigidus is more likely.
Treatment Options for Hallux Rigidus and Gout
Treating Hallux Rigidus
Mild cases of hallux rigidus can often be managed without surgery. Stiff-soled shoes, carbon fiber inserts and custom orthotics can reduce pain by limiting movement in the toe joint. Over-the-counter pain relievers and corticosteroid injections into the toe joint can also help with pain, while ice and anti-inflammatory medications can help with swelling.
When symptoms become more severe, surgical options are available. These include removing bone spurs (cheilectomy), fusing the joint (arthrodesis), or even replacing it in select cases. Your orthopedic provider will help you decide which option is best based on your activity level and the stage of arthritis.
“Surgery isn’t always necessary, but when conservative care fails, it can significantly improve pain and function,” notes Dr. Levy.
Treating Gout
Managing gout starts with controlling inflammation during flares. NSAIDs, corticosteroids or medications like colchicine are often prescribed to ease pain and reduce swelling. If gout becomes chronic, you may be prescribed medications to lower uric acid levels and prevent future attacks.
Long-term management also includes making changes to your diet and lifestyle such as cutting back on alcohol, red meat and sugary drinks and staying well hydrated.
“Treating underlying conditions like high blood pressure or kidney disease can also reduce your risk of repeat flares,” explains Dr. Sedghi.
Surgery is rarely needed for gout, but in severe cases with joint damage or large uric acid deposits (called tophi), it may be considered.
Prevention Tips for Big Toe Joint Pain
While not all cases can be prevented, there are things you can do to lower your risk or keep symptoms from getting worse.
If you're dealing with hallux rigidus, wear shoes that give your toes room to move and avoid high heels or tight toe boxes. Stretching and strengthening exercises can help maintain joint mobility.
To reduce your chances of a gout flare, drink plenty of water, maintain a healthy weight, and limit foods that are high in purines, such as organ meats, shellfish and alcohol. Your provider may also recommend blood tests to monitor uric acid levels.
When to See a Specialist for Big Toe Joint Pain
If you're experiencing ongoing toe pain, swelling or limited motion, especially if it's interfering with walking or sleeping, it’s time to talk to a provider. Your provider can do a physical exam, take X-rays or lab tests, and determine whether you’re dealing with gout, hallux rigidus or something else entirely.
Getting a clear diagnosis is the first step toward getting the right treatment and getting back on your feet.
If you're experiencing symptoms associated with gout or want to learn more about your treatment options, don’t wait – schedule an appointment online with your primary care provider today. They can help answer your questions, evaluate your symptoms and refer you to a specialist if needed.
Still need a primary care provider? Click HERE to find a provider near you.
If you’re experiencing symptoms that feel more like hallux rigidus then it’s time to see an orthopedic specialist.
At Riverside Orthopedic and Sports Medicine Specialists, our foot and ankle team offers the full spectrum of care, from conservative treatments to advanced surgical options.
Schedule an appointment online for your foot and ankle evaluation or call 757-534-9988 to schedule an appointment with an orthopedic specialist.
