Q: I have recently been getting pains in my big toe. I used to wear heels a lot but have put on weight and have stopped as they weren’t very comfortable. I had a full check-up recently and my bloods were fine. I don’t have any obvious lump. Could it be gout or is it more likely to be a bunion?

A: As you stopped wearing high heels some time ago, I presume the toe pain began subsequently and is not related to high heels. I agree that high heels are not comfortable, moreover they are not good for your foot, your posture or your back. Is there any chance your foot size may have increased a little due to your recent weight gain? It is common to go up by a half size (even a full size) after having children and with age-related change.

From your description above, it is unlikely to be gout as you said there is no obvious lump, therefore I presume there is no swelling or deformity. Gout results in a sudden severe onset of a painful hot swollen joint, typically at the base of the big toe. The joint is typically enlarged and erythematous (slightly red in appearance) and very different when compared to the same joint on the other foot. The pain gets worse for up to 12 hours and then starts to reduce over the next 7-10 days. The most common cause is due to a rise in uric acid levels in the bloodstream that deposit as urate crystals in the joint. You said recent blood tests were normal and you should check to see if your uric acid level was included.

As for bunions, you should notice a protrusion of the first Meta-Tarsal Phalangeal (MTP) joint. A bunion is a bony deformity of the joint at the base of the big toe which causes the big toe to move towards the middle of the foot and second toe. The degree of angulation (lateral deviation) of the big toe helps to define the severity of the deformity. The reason why bunions form in some people is multi-factorial with family history and tight/ill-fitting footwear being two significant factors. Foot anatomy, joint hyper-flexibility and biomechanics are likely to play a role.

The fact that bunions are rarely seen in parts of the world where people go barefoot points to the significance of comfortable footwear. Other risk factors include rheumatoid arthritis, psoriatic arthritis and gout. A foot X-ray allows the bony structure of the foot to be clearly seen and the extent of the deformity caused by the bunion. Surgical correction is generally considered with severe deformity, pain or discomfort.

Lastly, consider early degenerative or arthritis changes as a potential cause for your toe pain. Osteoarthritis (OA) of the first MTP joint (big toe) is common, particularly over 50 years old. Is there any chance you might have taken up running recently? Runners can experience pain in this joint when running long distances or perhaps after switching to a new brand or style of runner.

If you are at all concerned about your feet, call us today.




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