Dr. Ebraheim’s educational animated video describes painful conditions of the big toe.
Big toe pain is fairly common, since the feet are constantly exposed to stress, overuse and injury from waling and running such as with sports activity.
Arthritis
When the big toes has limited movement, it is often associated with arthritis of the big toe. Degenerative arthritis of the big toe is painful stiffness and swelling of the first metatarsophalangeal joint. The patient may need fusion of the joint.
Hallux Rigidus
Arthritis of the big toe joint may be present with large dorsal bone spurs. This is referred to as hallux rigidus. The condition restricts dorsiflexion of the big toe with swelling. There will be some cartilage remaining within the joint space and there will be bone spurring around the joint. The condition is treated by dorsal cheilectomy. Remove 25% of the dorsal aspect of the tarsal head including the dorsal osteophytes. The procedure is contraindicated if the pain is located in the midrange of joint motion (advanced arthritis need fusion).
Hallux Valgus (Bunion Deformity)
The condition is more common in women than in men. Once a bunion gets to be painful and shoe wear is uncomfortable, surgery may be needed.
Gout
The first metatarsal joint is the most common joint in the body to be affected by gout. Recurrent pain in the big toe occur from gout. Gout is caused by the build up of uric acid that looks like needles and the deposit of uric acid crystals inside the joint are negative. Gout may resemble infection. Sometimes there is white tophus or cloudy aspiration. Aspiration and analysis of the joint fluid is the best method for diagnosis. Xrays will show punched out periarticular lesions. Most people with high levels of uric acid do not have a gouty attack.
Turf toe
Turf toe is the common term used to describe an injury to the plantar plate and sesamoid complex of the MTP of the big toe. It is an injury to the joint at the base of the big toe caused by hyperextension of the big toe. Occurs in contact sports. The injury is seen more from playing on artificial turf since it is harder surface than grass with little “give” when force is placed on it. Xray may show fracture or displacement of the sesamoid. MRI may show disruption of the volar plate.
Sesamoiditis
There are two sesamoid bones, one tibular and one fibular. The sesamoiditis bones act like pulleys for the flexor tendons and are embedded into the tendons of the flexor hallucis brevis muscle. Sesamoiditis is generalized big toe pain at the bottom of the big toe. Sesamoids are important to the big toe region by absorbing weightbearing pressure and reducing friction on the metatarsal head and they protect the flexor hallucis longus tendon as it glides between the two sesamoid bones. Any chronic sesamoid condition that is unresponsive to conservative treatment may require surgery.

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