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Fellows Podiatry Blog

Bunions and big toe pain

By October 24, 2023November 20th, 2023No Comments
bunion, hallux rigidus

Bunions aka Hallux Valgus & other 1st MTPJ Pathologies:

MTPJ= metatarsal-phalangeal joint

Common Conditions and Treatments

The first metatarsophalangeal joint (1st MTPJ), also known as the big toe joint, is a crucial structure in the foot that plays a significant role in our daily activities.  We use the big toe to help propel the body over the foot and gain forward momentum in the gait cycle.  When issues arise within this joint, it can lead to discomfort and hinder mobility.  This blog discusses the 1st MTPJ pathologies, their causes, symptoms, and potential treatment options.

  1. Hallux Valgus (Bunions): Hallux valgus, commonly referred to as bunions, is a condition where the big toe deviates away from the midline of the foot, causing a bony prominence on the inner side of the joint. This can lead to pain, swelling, and difficulty in finding comfortable footwear.

Bunion Causes:

  • Genetics
  • poor footwear
  • Foot mechanics such as over pronation and hypermobility
  • Arthritis

Bunion Treatment:

  • Orthotics and supportive footwear to accommodate and offload
  • Bunion splints or padding
  • Physical therapy/exercise to help strengthen the foot
  • In severe cases, surgical intervention may be necessary.


2.Hallux Rigidus/Hallux rigidus is characterized by the stiffness and limited range of motion in the 1st MTPJ. This condition is often associated with arthritis, leading to cartilage degeneration within the joint and pain.


  • Osteoarthritis
  • Previous trauma
  • Overuse
  • Mechanics/foot posture


  • Anti-inflammatory medications
  • Physical therapy
  • footwear with rigid soles/rocker bottom soles
  • Custom orthotics to help offload and divert plantar forces
  • Cortico-steroid Joint injections
  • In advanced cases, surgical options like cheilectomy or joint replacement may be considered.

3.Sesamoiditis: Sesamoiditis is the inflammation of the sesamoid bones located beneath the 1st MTPJ. These small bones act as pulleys for the flexor tendons and can become irritated or injured, causing pain and discomfort.


  • Repetitive stress
  • High-impact activities
  • Improper footwear


  • Rest and immobilization
  • Cold compresses
  • Orthotics or specialized padding to offload
  • Physical therapy
  • Steroid injections

4.Gout in the 1st MTPJ: Gout is a form of arthritis caused by the build up of uric acid crystals in the joint. When gout affects the 1st MTPJ and it leads to intense pain, swelling, and redness.


  • High levels of uric acid in the blood
  • Diet high in purines
  • Genetics


  • Medications to manage uric acid levels
  • Anti-inflammatory drugs
  • Lifestyle modifications (diet, hydration)
  • Avoidance of trigger foods
Conclusion: 1st MTPJ pathologies can significantly and so they impact quality of life. It’s crucial to seek professional Podiatrist guidance if you experience persistent pain or discomfort in this joint. Early intervention and proper management can help alleviate symptoms and prevent further complications. Remember, a healthy 1st MTPJ is essential for pain-free, functional movement.


If you are suffering with any of the joint complaints above, consider booking a consultation with you fully registered, Podiatrist Joanna.  Fellows podiatry is located in Heswall, Wirral and covers surrounding areas such as Pensby, West Kirby, Irby, Greasby, Prenton, Parkgate and Neston.  Joanna is a specialist in biomechanical function of the foot and has over 20 years experience with NHS and private practice and is happy to take on new patients.

Call today or book online via my booking page.

Routine Chiropody and Podiatry treatments also available.