Battling the big toe joint blues

Aching hips, knees, and shoulders are common, and over time can lead to immobility. But so can an aching big toe. The joint at the base of the big toe — called the metatarsophalangeal or MTP joint — is the part of the toe that is affected.

What’s the MTP joint?

The MTP joint connects the first long bone (metatarsal) in the forefoot to the first bone of the big toe (phalanx). The joint bends with every step you take, so that you can push off and let the other leg move forward. But the MTP joint takes a beating during that process: for a brief moment as you push off, the MTP joint supports half of your body weight.

An aching MTP joint affects your ability to walk and exercise. Numerous conditions can strike the MTP joint. Following is information on three that are common.


Osteoarthritis, the wearing away of cartilage at the end of the bones, is a common MTP joint problem, often starting in middle age. Without cartilage, the space between bones decreases and the bones rub against each other. This can cause pain and lead to painful growths called osteophytes or bone spurs. Osteoarthritis can also cause a loss of flexibility in the MTP joint, a condition known as hallux rigidus.

But MTP arthritis isn’t always painful. “Often, big toe arthritis doesn’t cause symptoms. We commonly see people come in for other problems and then we see arthritis on an x-ray,” says Dr. Christopher Chiodo, chief of foot and ankle surgery at Harvard-affiliated Brigham and Women’s Hospital.

If MTP arthritis doesn’t hurt, your doctor may recommend that you simply avoid wearing high heels and instead wear stiff-soled shoes to reduce the motion of the MTP joint. “We only offer medical treatments if we need to,” Dr. Chiodo says.

Treatment comes in if there’s pain. In that case, Dr. Chiodo often prescribes a carbon-fiber base plate to insert inside the shoe and decrease joint motion. “And some patients have relief with a rocker-bottom shoe,” he adds.

Surgery to remove bone spurs, clean out the arthritic MTP joint, or fuse the bones is a last resort. Dr. Chiodo says it may be necessary if there’s daily pain that’s lasted for more than three months, if the pain interferes with your daily activities, and if you haven’t responded to nonsurgical options.


Family history and tight shoes with narrow toe boxes may play a role in creating a bunion, a condition in which the first metatarsal bone juts outward at the joint, causing the phalanx bone to point toward the other toes of the foot. “Compressing the toes together over years weakens the ligaments that hold the toe in a straight position,” Dr. Chiodo explains.

If bunions don’t hurt, avoid surgery, Dr. Chiodo recommends. “You can wear shoes with a wide toe box or stretch your shoes to make room for the bulging MTP joint,” he says. You’ll also want to avoid wearing heels, which continue compressing the toes together.

If your bunion hurts, surgery aims to realign the bones of the foot so the big toe is in a straight position. “Sometimes we have to cut the bone and reset it, and sometimes we have to fuse it,” Dr. Chiodo explains. Afterward, you may have to wear a special shoe or boot and avoid putting weight on your foot for six weeks. However: “Bunions can recur. It’s one of the most common complications. Wearing shoes with a narrow toe box will increase the chance that this happens,” Dr. Chiodo warns.


Gout is a type of inflammatory arthritis that commonly affects the MTP joint. It strikes men more than women and results from high uric acid levels.

We normally flush out uric acid — a waste product from the breakdown of chemicals called purines—in the urine. But if your body makes too much uric acid or doesn’t flush it out adequately, it can form sharp crystals that often settle in the MTP joint.

Symptoms show up suddenly: excruciating pain, warmth, redness, and swelling. Other joints besides the MTP joint can be affected, as well — typically the ankles, feet, hands, wrists, or knees.

The fix: go to your doctor for relief and to avoid another attack, which is likely. Your doctor might recommend a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin), naproxen (Aleve), or a prescription NSAID like indomethacin (Indocin) to relieve the pain and swelling of an attack in process. Another option is a corticosteroid, taken orally or injected at the joint.

To prevent new attacks, several prescription medications, such as allopurinol (Zyloprim, Aloprim), are used to lower uric acid in the body. Cutting out purine-rich foods and drinks (shellfish, red meat, alcohol, and soda) will go a long way toward preventing flare-ups in the future.

Below are spiritual recipe for health and wellness: Matthew E. McLaren

I pray that out of his glorious riches he may strengthen you with power through his Spirit in your inner being, so that Christ may dwell in your hearts through faith. And I pray that you, being rooted and established in love. Ephesians 3:16-17 NIV

 Therefore I tell you, whatever you ask for in prayer, believe that you have received it, and it will be yours. Mark 11:24 NIV

Now faith is confidence in what we hope for and assurance about what we do not see. Hebrews 11:1  NIV

For we live by faith, not by sight. 2 Corinthians 5:7 NIV

May the God of hope fill you with all joy and peace as you trust in him, so that you may overflow with hope by the power of the Holy Spirit? Romans 15:13 NIV

But when you ask, you must believe and not doubt, because the one who doubts is like a wave of the sea, blown and tossed by the wind. James 1:6 NIV

And without faith it is impossible to please God, because anyone who comes to him must believe that he exists and that he rewards those who earnestly seek him. Hebrews 11:6  NIV

Though you have not seen him, you love him; and even though you do not see him now, you believe in him and are filled with an inexpressible and glorious joy, for you are receiving the end result of your faith, the salvation of your souls. 1 Peter 1:8-9 NIV

Then Jesus said, “Did I not tell you that if you believe, you will see the glory of God?” John 11:40 NIV

Because you know that the testing of your faith produces perseverance. James 1:3 NIV

Jesus said to her, “I am the resurrection and the life. The one who believes in me will live, even though they die; and whoever lives by believing in me will never die. Do you believe this?” John 11:25-26 NIV

Accept the one whose faith is weak, without quarreling over disputable matters. Romans 14:1 NIV

But you, man of God, flee from all this, and pursue righteousness, godliness, faith, love, endurance and gentleness. 1 Timothy 6:11 NIV

For everyone born of God overcomes the world. This is the victory that has overcome the world, even our faith. 1 John 5:4 NIV

If I have the gift of prophecy and can fathom all mysteries and all knowledge, and if I have a faith that can move mountains, but do not have love, I am nothing. 1 Corinthians 13:2 NIV

I have set my heart on your laws. Psalm 119:30 NIV

“Go,” said Jesus, “your faith has healed you.” Immediately he received his sight and followed Jesus along the road. Mark 10:52 NIV

Then Jesus declared, “I am the bread of life. Whoever comes to me will never go hungry, and whoever believes in me will never be thirsty.” John 6:35 NIV

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