Did you know that nearly 1 in 3 adults over the age of 40 experience some form of big toe pain, and one of the most common causes is a bunion? Whether it’s a dull ache or a sharp twinge when walking, toe pain can really disrupt your daily rhythm and possibly change certain levels of muscle activation throughout the body. Let’s break it down together and help you understand what can happen — and most importantly, what you can do about it!
Common conditions linked to big toe pain
Big toe pain can stem from several different causes, including:
- Gout
- Osteoarthritis
- Turf toe (sports-related ligament injury)
- Sesamoiditis (inflammation around the tendons under the big toe)
- Morton’s neuroma (nerve-related foot pain)
- Hammer toe, claw toe, mallet toe
- Hallux valgus — more commonly known as bunions
Today, we’re focusing on bunions because they’re incredibly common — especially in women and older adults. A recent systematic review found that 28.4% of people over 40 have big toe pain, with a strong association to bunions (Nix, Smith, & Vicenzino, 2010).
What is a bunion (Hallux Valgus)?
A bunion is a bony deformity of the big toe joint (metatarsophalangeal joint) that causes the big toe to lean inward, toward the second toe. Over time, this shift creates a noticeable bump on the inside of the foot. The area can become red, swollen, stiff, and painful, especially when walking or wearing shoes.
According to Menz et al. (2016), the severity of hallux valgus is directly linked to functional limitations in walking, balance, and even increased fall risk in older adults.
What causes bunions?
There isn’t one single cause — bunions are multifactorial:
👣 Genetics: If your parents have bunions, your chances are up to 70% higher (Zhang et al., 2018).
🦶 Foot shape, mobility and biomechanics: Flat feet or over pronation(where your foot loses the arch and looks like it’s rolling inwards), hypermobility, and poor foot and lower limb biomechanics can contribute.
👠 Footwear: Tight or narrow shoes and high heels increase mechanical stress on the big toe.
🧬 Underlying medical conditions: Conditions like rheumatoid arthritis or neuromuscular disorders can play a role.
🏃♂️ Repetitive stress or standing for long periods, especially on hard surfaces, can also contribute.
Symptoms of bunions and big toe pain
Some of the more common signs and symptoms include:
- A visible bump at the base of the big toe
- Pain and tenderness over the joint
- Swelling and redness
- Stiffness or reduced range of motion
- Difficulty wearing shoes comfortably
- Tingling or burning if nerves are affected
In more progressed cases, the second and third toes may start to deform as well — creating hammertoe, claw toe, or mallet toe appearances.
What can you do about big toe pain and bunions?
✅ Footwear: This is the easiest place to start. Look for:
- A wide toe box
- Minimal seams over the bunion area
- Good arch support
- A proper fit at the end of the day (when your feet are naturally more swollen)
🦶 Podiatry and Physiotherapy:
- Your physiotherapist can assess how your foot/toes, ankle, knee, hip moves and help with motor control retraining around any areas that are affected.
- Exercises that improve the strength of the intrinsic(inside) foot muscles have been shown to reduce bunion symptoms (Jeon et al., 2022).
- Exercises that targeted not just the foot but hip stabilisers such as the glutes were likely more effective at maintaining foot arch height (Engkananuwat, & Kanlayanaphotporn, 2023 and Goo, Kim, & Lim, 2016)
- Manual therapy, soft tissue techniques, and gentle joint mobilisations can relieve pain.
- Padding, toe spacers, or taping can reduce pressure on the bunion.
🩺 Orthotics:
- Custom or semi-custom insoles can help redistribute load across the foot and take pressure off the big toe joint (Munteanu et al., 2011).
🛌 Lifestyle Modifications:
- Break up long standing periods
- Alternate between sitting and walking throughout the day
- Monitor symptoms during exercise and adapt load accordingly
🔪 Surgery:
- If the bunion is severe, affects your daily life, and isn’t responding to conservative treatment, surgery might be considered.
- There are several surgical techniques available — your podiatric surgeon can advise based on X-rays, severity, and mobility.
Final thoughts
Big toe pain — especially from bunions — can sneak up on you and get progressively worse if not managed early. But the great news is that with early intervention and a bit of toe TLC, many people find significant relief and find it very manageable. If your toe is aching and affecting your walking, footwear, or exercise, a visit to your local physiotherapist or podiatrist might be just what your feet need!
Check out this guide to gluteal tendinopathy here
https://bodysmartphysio.fit/gluteal-tendinopathy-an-evidence-based-guide/
Click below if you need some helpful tips on lower back pain.
https://bodysmartphysio.fit/lower-back-pain-evidence-based-guide-for-a-healthier-lower-back/
References
Engkananuwat, P., & Kanlayanaphotporn, R. (2023). Gluteus medius muscle strengthening exercise effects on medial longitudinal arch height in individuals with flexible flatfoot: a randomized controlled trial. Journal of exercise rehabilitation, 19(1), 57–66. https://doi.org/10.12965/jer.2244572.286
Goo, Y. M., Kim, T. H., & Lim, J. Y. (2016). The effects of gluteus maximus and abductor hallucis strengthening exercises for four weeks on navicular drop and lower extremity muscle activity during gait with flatfoot. Journal of physical therapy science, 28(3), 911–915. https://doi.org/10.1589/jpts.28.911
Jeon, H., Park, S., & Kim, Y. (2022). Effects of foot intrinsic muscle strengthening on hallux valgus angle and pain. Journal of Physical Therapy Science, 34(3), 215–221. https://doi.org/10.1589/jpts.34.215
Menz, H. B., Roddy, E., Marshall, M., Thomas, E., & Peat, G. (2016). Epidemiology of hallux valgus in older adults: A systematic review. Osteoarthritis and Cartilage, 24(1), 11–18. https://doi.org/10.1016/j.joca.2015.07.012
Munteanu, S. E., Perret, C., Scott, L. A., & Basser, J. R. (2011). Effectiveness of footwear and orthoses for hallux valgus: A systematic review. Journal of Foot and Ankle Research, 4(1), 1–10. https://doi.org/10.1186/1757-1146-4-4
Nix, S., Smith, M., & Vicenzino, B. (2010). Prevalence of hallux valgus in the general population: A systematic review and meta-analysis. Journal of Foot and Ankle Research, 3(1), 21. https://doi.org/10.1186/1757-1146-3-21
Zhang, Y., Jordan, J. M., & Lieu, J. (2018). Hallux valgus and risk of incident disability in community-dwelling older adults. The American Journal of Medicine, 131(5), 567–572. https://doi.org/10.1016/j.amjmed.2017.11.033
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