Pain around the big toe joint is one of the most common reasons patients come to see me in clinic. For some, the problem is a gradually enlarging bump at the base of the toe that rubs against shoes. For others, it’s stiffness, aching, and swelling that seem to worsen with every step.
Although these symptoms often overlap, the causes can be quite different - the two most frequent culprits being bunions and big toe arthritis.
Understanding which you’re dealing with is key to getting the right treatment and keeping you comfortably on your feet.
A bunion (hallux valgus) is a structural deformity of the big toe joint, where the toe begins to drift towards its neighbour and a bony bump develops on the inside of the foot. Over time, this misalignment can cause pressure, irritation, and discomfort — particularly in tight or narrow shoes.
In my practice, I often see bunions that have been slowly progressing for years. Many patients tell me they first noticed a slight bump that only became painful later on. Bunions can run in families and are often linked to inherited foot shape, but poorly fitting footwear can certainly accelerate their development.
Big toe arthritis is a different condition altogether. Rather than a visible bump on the side of the foot, the problem lies within the joint itself. The smooth cartilage that allows the big toe to move freely becomes worn down, leading to pain, stiffness, and swelling. Some patients describe a “grinding” or “catching” sensation when they try to bend their toe.
Unlike bunions, big toe arthritis often causes difficulty during push-off when walking or running, and the pain tends to worsen with activity rather than shoe pressure alone.
A bunion typically presents as a visible bump at the base of the big toe, with the toe angling inwards.
In contrast, arthritis often causes a stiff, swollen joint with little outward deformity. Patients with arthritis tend to notice a gradual loss of motion (Hallux Rigidus) and discomfort even in roomy footwear.
In hallux rigidus there sometimes is a bump, but it is usually more on the top of the joint due to bony growth. It’s something patients can feel, which may cause trouble in shoes.
During a consultation, I’ll assess alignment, mobility, and tenderness, often supported by an X-ray. This helps confirm whether we’re dealing with a structural deformity or joint wear and tear - and guides how best to manage it.
Treatment: finding the right balance
For both bunions and arthritis, we always start with non-surgical management.
That said, when pain persists or starts to limit daily activities, it’s time to consider surgical options.
When conservative treatments no longer relieve symptoms, bunion surgery can be highly effective. The aim is not just to remove the bump but to realign the bones and restore the natural shape of the foot.
There are different surgical ways of correcting a bunion and the type of operation will be adjusted depending on the severity of the bunion.
The most common approach I perform is an osteotomy, where the bone is precisely cut and repositioned before being fixed with small screws. This restores alignment and allows the joint to function more normally.
In more advanced cases, particularly where arthritis has also developed, a fusion (arthrodesis) of the joint may be the best way to eliminate pain and stabilise the toe.
Recovery typically involves a period of protected weight-bearing in a special shoe, followed by gradual return to normal footwear. Most of my patients are walking comfortably again within a few weeks - and often remark how much better their foot feels once the pressure and deformity are gone.
For big toe arthritis, the choice of surgery depends on how much cartilage has been lost. In earlier stages, joint-preserving procedures can be performed; this involves removing small bone spurs and freeing up movement in the joint. It’s a relatively simple operation with quick recovery and excellent results in suitable cases.
For more advanced arthritis, where the joint surfaces are severely worn, I often recommend a joint fusion (arthrodesis). This procedure permanently joins the bones of the big toe joint together, removing pain completely and restoring stability.
Although you lose some movement, most patients find they can walk, hike, and even run without discomfort after recovery.
In certain cases, particularly for lower-impact lifestyles, a joint replacement (arthroplasty) may be an option to preserve motion.
Both bunions and big toe arthritis are common - and I see them in everyone from active runners to patients who simply want to enjoy walking without pain. The key is early assessment and tailored treatment.
If you’re struggling with pain, stiffness, or deformity around your big toe, don’t ignore it. A careful clinical assessment and imaging can quickly clarify the cause, and with the right approach, whether it’s simple footwear advice or a modern surgical correction, there’s every reason to expect a smooth, active recovery.
Q1: How do I know if I have a bunion or big toe arthritis?
A bunion causes a visible bump on the side of the big toe and is often irritated by tight shoes. Big toe arthritis, however, causes stiffness and deep joint pain even in roomy footwear. An X-ray and clinical examination are the best ways to confirm which condition you have.
Q2: Do bunions always need surgery?
Not always. Many patients manage their bunion pain successfully with wide shoes, orthotics, and activity modification. Surgery is considered if pain persists or the deformity worsens despite conservative care.
Q3: What are the signs that I might need surgery for big toe arthritis?
If your toe becomes increasingly stiff or painful, especially during walking or exercise, and non-surgical treatments are no longer effective, it may be time to discuss surgical options such as cheilectomy, joint fusion, or replacement.
Q4: How long is recovery after bunion surgery?
Most patients can walk in a protective shoe immediately after surgery and transition to normal footwear within 6 - 8 weeks. Full recovery, including swelling reduction and return to sport, can take a few months depending on the procedure performed.
Q5: Can bunions and arthritis occur together?
Yes. Long-standing bunions can sometimes lead to arthritic changes in the big toe joint. This is why early assessment and management are important - to prevent progressive joint damage.
NHS – Bunions Overview:
https://www.nhs.uk/conditions/bunions/
(Symptoms, causes, treatment, and when to see a specialist.)
NHS – Osteoarthritis:
https://www.nhs.uk/conditions/osteoarthritis/
(Information on arthritis management and self-care.)
Mr Martin Klinke is one of London’s most trusted, and experienced foot specialists. He performs many bunion surgeries each year, and is a highly skilled surgeon.
He offers this surgical treatment to private self-funded and insured patients at London Bridge Hospital, BUPA Cromwell, and New Victoria Hospital. He also runs outpatient clinics at Chiswick Outpatient & Diagnostic Centre, The Shard, Canary Wharf and One Welbeck.
You can find all his patient reviews here.
