Bunion vs. Big Toe Arthritis: What’s Causing Your Pain?

What Is a Bunion and How Does It Form?

A bunion, medically known as hallux valgus, is a deformity of the big toe joint where the metatarsophalangeal (MTP) joint shifts out of alignment. This causes the big toe to lean toward the second toe, creating a bony bump on the side of the foot. Bunions can be hereditary or develop over time due to improper footwear, foot structure, or repetitive pressure on the joint.

Symptoms include swelling, redness, and tenderness around the joint. As the bunion progresses, pain can increase, particularly when walking or wearing shoes that compress the forefoot. The condition worsens without intervention, especially if underlying biomechanical issues remain unaddressed.

What Is Big Toe Arthritis and Why Does It Happen?

Big toe arthritis, also known as hallux rigidus, is a degenerative joint disease that affects the cartilage of the first MTP joint. It develops over time as the cartilage between the bones wears down, leading to pain, stiffness, and reduced range of motion.

Unlike bunions, which involve a shift in bone alignment, arthritis involves inflammation and damage within the joint itself. Causes include repetitive stress, injury, and genetic predisposition. Patients may notice pain when pushing off during walking, stiffness in the morning, or swelling around the joint.

How Can You Tell the Difference Between a Bunion and Arthritis?

While bunions and big toe arthritis can share some symptoms, there are key differences that help distinguish the two:

• Location of Pain: Bunions usually cause pain on the side of the toe joint; arthritis typically causes pain at the top of the joint.
• Appearance: Bunions present as a visible bump on the side of the foot, whereas arthritis may not show an obvious deformity.
• Range of Motion: Arthritis often limits toe movement, especially upward motion. Bunions may restrict movement due to crowding but don’t typically stiffen the joint.
• Progression: Bunions tend to develop gradually with a visible shift in toe position. Arthritis may progress with increasing joint stiffness and pain.

A podiatrist can diagnose the condition through a physical exam, patient history, and imaging such as X-rays to assess joint integrity and alignment.

Are Treatments for Bunions and Arthritis the Same?

Treatment depends on the diagnosis, but conservative approaches overlap. Early management is key to reducing symptoms and preserving joint function for both conditions.

For Bunions:

• Wearing shoes with a wide toe box
• Using bunion pads or toe spacers
• Custom orthotics to correct alignment
• Physical therapy or targeted exercises

For Big Toe Arthritis:

• Rigid-sole shoes or rocker-bottom footwear
• Anti-inflammatory medications
• Corticosteroid injections for joint pain
• Physical therapy to maintain mobility

Surgical options also differ. Bunion surgery typically realigns the bones and soft tissues, while arthritis surgery may involve joint fusion (arthrodesis), bone shaving (cheilectomy), or joint replacement.

When Should You See a Specialist?

If you’re experiencing ongoing toe pain, swelling, or difficulty walking, consult a foot and ankle specialist. Early diagnosis and treatment can prevent further joint damage and improve long-term outcomes.

A podiatrist or orthopedic foot specialist can provide personalized care, including diagnostic imaging, gait analysis, and treatment recommendations. Whether it’s a bunion or arthritis, early intervention often reduces the need for surgical procedures later.