What’s the Difference Between a Bunion (Hallux Valgus) and Big Toe Arthritits (Hallux Limitus)?
It is not at all unusual for patients to confuse bunions with big toe arthritis because both these conditions can cause pain and a bump and enlargement at the big toe joint. But they are actually very different conditions.
What’s a Bunion?
A bunion or hallux valgus is when the big toe (1st metatarsal) moves medially out of position. Much like a bow, in a bow-and-arrow situation, as the bow is pulled back, the wood of the bow bends and changes shape. So in the case of a bunion, as the bones move out of their normal position, the tendon pulls the great toe inwards, much like the string of a bow-and-arrow.
This starts out as a minor annoyance, but then (sometime quickly) becomes a bigger problem when shoes start rubbing on the bump. When that happens and the pain begins, it’s very wise to seek the attention of a podiatrist. While there is no major limitation in the range of motion from a bunion, if the deformity is allowed to progress unabated, the great toe joint can actually start to dislocate and then your minor pain will progress and you may start to experience significant joint pain and degeneration.
What’s Big Toe Arthritis (Hallux Limitus or Hallux Rigidus)?
Big Toe Arthritis, also know technically as “Hallux Limitus” or “rigidus arthritis of the great toe joint” and occurs when the big toe (1st metatarsal) moves upwards or begins to form bone spurs, which limits the range of motion of the toe. The jamming of the joint causes pain, swelling and tenderness with activity.
Many people are predisposed to big toe arthritis because of the biomechanical make-up of their toe joint. It can become much worse after an injury or repetitive movements like high-heeled shoes and some sports.
The symptoms of big toe arthritis are different than those of bunions. Big toe arthritis usually starts with a feeling of stiffness of the joint and can be accompanied by swelling and redness. This usually progresses to a decrease in range of motion, a crunching feeling when moving the joint and then a bump that forms toward the top of the joint, not the side of the toe like bunions.
The pain of hallux rigidus is a result of the arthritis in the joint, bone spurs and possible loose bodies that break off from the bone spurs. The pain from a bunion on the other hand, is caused by the bump rubbing on the side of the shoe.
When Bunions and Big Toe Arthritis Occur Together
Bunions and big toe arthritis can occur together in what is considered a more complex foot deformity.
There can be some arthritis with a bunion due to the abnormal position of the joint. Usually the bunion deformity has progressed and is injured by repetitive trauma or a distinctive injury. This starts the progression of the arthrits.
There can also be a bunion component to big toe arthritis because the bone can move a bit over. This is often corrected at the time of the joint clean up.
Bunions vs. Big Toe Arthritis: how their treatments vary
The treatment of hallux limitus (big toe arthritis) is crucial in the early stages. Once you have destroyed the cartilage in your joint, there is nothing a physician or surgeon can do to make more cartilage. Research is underway trying to replace or regrow cartilage, but we are many years from a solution.
Hallux limitus in the early stages can be controlled with a custom orthotic, which helps take pressure off the big toe and redistribute it through the rest of the foot. A clean up procedure known as a cheilectomy removes scar tissue and spurs from the joint. This allows for better range of motion and slows down the progression of the arthritis.
Some patients can really benefit from a surgical procedure to realign and shorten the metatarsal to give the joint better biomechanics and more joint space. Unaddressed Hallux limitus leads to complete joint destruction and the need for a toe fusion or joint replacement.
The flip side of this is that patients with your traditional bunion can often delay treatment until they start to have pain. Bunions in the early stages are a considered a cosmetic concern. The joint is usually not damaged until the later stages but it is important to seek medical attention once it starts to hurt so the joint is not permanently injured. But a bump, in the absence of pain, can wait.