Why Does My Big Toe Joint Hurt? It Might Not Be a Bunion. It might be Hallux Limitus.
As a podiatric surgeon who specializes in great toe joint pain, I meet many patients who turn to the internet when their big toe starts to hurt. A quick search often leads them to assume they have a bunion. But here’s the truth: not all bunions are bunions.
One common culprit behind pain on the top of the big toe joint is a condition called hallux limitus (or, in its more advanced form, hallux rigidus).
What Is Hallux Limitus?
Hallux limitus happens when the big toe joint loses its normal range of motion. Instead of bending smoothly, the joint becomes stiff and painful—especially on top. This stiffness is often caused by a bony spur that develops at the top of the joint. Unlike bunions, which push the big toe sideways, hallux limitus is more of a “jamming” problem where the joint doesn’t move the way it should.
Genetics play a big role. If your parents or grandparents had spurring in this joint, you may be predisposed to the same problem. I know this firsthand—not only do I suffer from hallux limitus myself, but my father and four older brothers also deal with this condition.
Dr. Steinke’s foot prior to surgery. See close up of spur on top of great toe joint below
Close up of spur on the metatarsal. Called a dorsal flag because it looks like a flag blowing in the wind. Develops as the great toe jams the bone behind it (metatarsal).
Symptoms You Might Notice
Pain directly on top of the big toe joint (not the side like a bunion)
Discomfort when you push off while walking, running, or climbing stairs
Stiffness that makes bending the toe difficult
A visible bump or spur on top of the joint (see picture above)
Increased pain in tight shoes or when performing activities that require bending the toe
Conservative Treatment Options
If you’re dealing with this type of pain, there are several non-surgical approaches that can bring relief:
Shoe modifications: Wearing shoes with a roomier toe box or stiffer sole can reduce painful motion.
Custom orthotics: These can help offload pressure from the joint and reduce jamming. (These are often covered by insurance and fit comfortably in your shoes)
Injections: Corticosteroid injections can calm down inflammation for temporary relief.
These treatments can manage symptoms, but they don’t correct the underlying spur.
Surgical Solutions for Long-Term Relief
When pain persists and begins limiting your lifestyle, surgery may provide the most effective solution. Options include:
Spur before cheilectomy surgery, painful and limits motion
Spur has been surgically removed in a 20 minute procedure, reducing or eliminating pain, and improving joint motion.
Cheilectomy: A relatively simple procedure where we remove the bone spur on top of the joint. This restores motion and relieves pain for many patients. In fact, I personally had a cheilectomy over 10 years ago and have been able to return to running—even completing half marathon distances—with little to no pain.
Joint fusion (arthrodesis): In more advanced cases where arthritis has worn down the joint, fusing the toe joint can eliminate pain entirely. Patients are often surprised to learn they can still return to yoga, running, hiking, or other activities—sometimes performing better than before—because the painful joint is no longer limiting them. In my own surgical practice, I use the Speed™ MTP Fusion System from Treace Medical. This specially designed, low-profile plate reduces the risk of needing hardware removal and, in my experience, allows patients to begin immediate weightbearing after surgery in a protective boot.
Speed MTP from Treace medical. Before surgery progressive arthritis (right) barely allows motion but with pain, after fusion (left) motion is eliminated but patients can still be very active just with improved or resolved pain.
The Bottom Line
If you have persistent pain in your big toe joint, don’t assume it’s just a bunion. Hallux limitus and hallux rigidus are common causes of dorsal joint pain and require a different approach.
Dr. Paul Steinke, the #3DBUNIONDOC
As both a surgeon and someone who personally lives with this condition, I understand not only the medical side but also the day-to-day frustration it causes. That’s why I encourage you to schedule an appointment with me, the 3D Bunion Doc, for a thorough evaluation. Together, we’ll determine whether conservative care or surgery is the right path for you—so you can get back to moving, exercising, and living without your big toe holding you back.
Call for a consultation 817-416-6155