If your big toe has started to hurt, you may be wondering what is actually going on. Two of the most common causes of big toe joint pain are bunions and hallux rigidus, and they can feel surprisingly similar at first. Both affect the metatarsophalangeal (MTP) joint at the base of the big toe. Both cause pain when walking. But they are very different conditions with distinct causes, appearances, and treatment pathways.
What is a bunion?
A bunion, known clinically as hallux valgus, is a structural deformity of the big toe joint. The first metatarsal bone drifts inward while the big toe angles outward towards the second toe. This creates the characteristic bony bump you can see and feel on the inner side of the foot at the base of the big toe.1
The term “bunion” is often used broadly to describe any painful bony prominence on the foot and strictly speaking it can be present without the hallux valgus deformity or toe drifting. Most commonly, the term is used to describe the bump as part of the hallux valgus and so it has become associated to this condition.
The bump itself is not a growth of new bone. It is the head of the metatarsal bone shifting out of position. This is why devices such as toe splints and gel spacers can relieve pressure but cannot reverse the deformity. Once a bunion has formed, only surgery can realign the bone.
Bunions are common across the UK. Around one in four adults is affected, with the rate rising sharply after the age of 50.2 Women develop bunions three to four times more often than men. Genetics plays the largest role, though narrow or high-heeled footwear and underlying foot mechanics can accelerate progression in people who are already predisposed.
Symptoms of a bunion
The key signs to look out for include:
- A visible bony bump on the inner side of the big toe joint
- The big toe angling inward towards the second or third toe
- Pain, swelling, or redness at the base of the big toe, particularly after time on your feet
- Difficulty fitting into shoes that previously fitted well
- Corns, calluses, or a hammer toe forming on the adjacent toes
What is hallux rigidus?
Hallux rigidus is arthritis of the first metatarsophalangeal (MTP) joint, the large joint at the base of the big toe. “Hallux” refers to the big toe; “rigidus” reflects the progressive stiffness that develops as the cartilage inside the joint wears down.3
As the cartilage erodes, bone rubs directly against bone and bony spurs called osteophytes form on top of the joint. These restrict the upward movement of the toe. Every step you take requires the big toe to bend upward; when the joint cannot move freely, pain follows.
Hallux rigidus is the most common arthritic condition of the foot. Research suggests it affects approximately one in 40 adults over the age of 50.4 In its early form, some joint movement remains, and symptoms can come and go. As it progresses, pain can occur even at rest. There is a less common condition called “hallux limitus’” that can cause similar symptoms of stiffness without arthritis and treatment is therefore different. Your consultant will examine your foot and diagnose what condition is causing your symptoms.
Symptoms of hallux rigidus
Common signs include:
- Pain and stiffness when bending the big toe upward, particularly when walking, climbing stairs, or running
- A hard, visible bony lump on top of the big toe joint (rather than on the inner side)
- Swelling and aching at the end of the day or after activity
- Pain that occurs even at rest in more advanced cases
- A tendency to walk on the outer edge of the foot to offload the painful joint, which can lead to secondary hip or knee discomfort
Bunion vs hallux rigidus: the key differences at a glance
The table below summarises the main differences between the two conditions.
|
Feature
|
Bunion (hallux valgus)
|
Hallux rigidus
|
|---|---|---|
|
What causes it
|
Genetics, footwear, and foot mechanics
|
Cartilage wear, injury, and genetics
|
|
Where the bump is
|
Inner side of the big toe joint
|
On top of the big toe joint
|
|
Key symptom
|
Visible angular deformity; big toe drifts inward
|
Stiffness and pain when bending the toe upward
|
|
Confirmed by
|
Clinical examination and X-ray showing angular deformity
|
X-ray showing reduced joint space and osteophytes
|
|
Can non-surgical care help?
|
Yes, to manage symptoms
|
Yes, especially in the early stages
|
Note: having a bunion does not prevent you from also developing hallux rigidus in the same foot. Both conditions can coexist, which is one reason a proper diagnosis requires clinical examination and imaging.
What causes a bunion?
Bunions are predominantly genetic. If a parent or grandparent had one, your risk is considerably higher.44 The underlying mechanism involves an inherited foot structure and ligament laxity that allows the joint to drift progressively out of alignment. Flat feet or hypermobility, prolonged time on your feet, and wearing narrow or high-heeled shoes over many years are contributing factors. Footwear alone does not cause a bunion, but it can speed up progression in someone who is already predisposed.
What causes hallux rigidus?
The most common cause is gradual cartilage wear inside the big toe joint over time. This is the same process that drives osteoarthritis in the hip or knee. Risk factors include:5
- Previous injury to the big toe joint, including stubbed toes or sports impact
- A family history of foot arthritis
- A longer first metatarsal bone, which places more load through the joint with each step
- Flat feet or abnormal foot mechanics
- Repetitive stress from high-impact activities such as running or jumping
Unlike a bunion, hallux rigidus affects men and women in roughly equal numbers.6
How to tell the difference at home
Look at the bump
With a bunion, the bump sits on the inner side of the foot at the base of the big toe, and the toe itself angles away from its natural position. With hallux rigidus, the visible lump (when present) tends to sit on top of the joint. The toe remains broadly straight but feels stiff or blocked when you try to move it upward.
Test the movement
Gently press your big toe upward towards your shin. If the movement is significantly restricted and causes immediate pain, hallux rigidus is the more likely explanation. If the toe moves fairly freely but angles towards the other toes, a bunion is more likely.
Consider your pain pattern
Bunion pain is typically a burning or aching sensation on the inner side of the foot, often made worse by shoes rubbing against the bump. Hallux rigidus pain tends to be deeper, within the joint itself, and is triggered by movement, particularly pushing off to walk or run.
These checks give useful pointers, but they cannot replace imaging. An X-ray is the standard tool for confirming a diagnosis and assessing its severity.
Not sure what is wrong with your big toe? Mr Francesc Malagelada offers private consultations at four central London clinics, with no GP referral required. Book an appointment at footankletreatments.co.uk
Mr Francesc Malagelada
Mr Francesc Malagelada is a highly respected Consultant Trauma and Orthopaedic Surgeon based at the Royal London Hospital, the largest Trauma Centre in the UK. He has a special interest in foot and ankle surgery and treats common conditions such as bunions, sports injuries, ligament damage, tendon issues, as well as complex conditions that require reconstruction surgery. Mr Malagelada takes a patient-centric approach to care and offers both surgical and non-surgical options to adapt to each patient’s lifestyle.
Treatment options for bunions
Non-surgical options can manage bunion symptoms effectively but cannot correct the underlying deformity. Wider footwear with a deep toe box, custom orthotics to address contributing foot mechanics, targeted physiotherapy, and ultrasound-guided injections to calm acute inflammation are all options worth trying first.
When pain is persistent, the deformity is progressing, or quality of life is significantly affected, surgery may be recommended. Mr Malagelada typically performs minimally invasive (keyhole) bunion correction through incisions of just 2 to 3 mm, using live X-ray guidance throughout. Published research, including Mr Malagelada’s own studies, shows this approach is associated with less post-operative pain, reduced stiffness, smaller scars, and a faster return to everyday footwear compared with traditional open surgery.7
For more details on what keyhole bunion surgery involves and what recovery looks like, see Mr Malagelada’s dedicated page on keyhole surgery.
Treatment options for hallux rigidus
The right treatment depends on the grade of arthritis, your activity level, and what you have already tried. Non-surgical management can be highly effective, particularly in the early stages (hallux limitus) before joint damage becomes advanced.
Non-surgical options include stiff-soled or rocker-bottom footwear to reduce load through the joint, custom orthotics, anti-inflammatory medication, and ultrasound-guided injections. NICE-endorsed guidelines support corticosteroid injections for short-term pain relief and hyaluronic acid (joint lubricant) injections for longer-term symptom management in mild to moderate cases.8
When non-surgical care has not provided sufficient relief, surgical options include:
- Cheilectomy (keyhole removal of bone spurs) — preserves joint movement and is most suitable for mild to moderate disease
- Arthrodesis (joint fusion) — eliminates pain by fusing the joint; recommended for severe or end-stage arthritis
- Joint replacement (arthroplasty) — suitable for selected patients who wish to preserve movement
Your consultant will discuss which approach is most appropriate for your grade of arthritis, your lifestyle, and your goals. For more information, see Mr Malagelada’s hallux rigidus treatment page.
When should you see a specialist?
You do not need to be in severe pain to seek an assessment. An earlier review usually means more treatment options, a lower chance of needing surgery, and a clearer picture of what is actually happening in your foot.
Consider booking an appointment if any of the following apply:
- Your big toe pain has lasted longer than six weeks and is not improving
- You are changing the way you walk to avoid pain
- Pain is affecting your sleep, work, or physical activity
- You have already tried wider footwear or painkillers without lasting relief
- You want to understand your diagnosis before deciding whether to pursue treatment
Frequently asked questions
Are bunions and hallux rigidus the same thing?
No. A bunion (also known as hallux valgus) is a structural deformity where the big toe drifts inward and a bony bump forms on the inner side of the foot. Hallux rigidus is arthritis of the big toe joint, where the cartilage wears down, causing stiffness and pain. Both affect the same joint but are different conditions with different appearances and different treatments.
Can I have both a bunion and hallux rigidus?
Yes. Both conditions can affect the same foot and even the same joint at the same time. This is more common than many people realise, which is one reason a proper clinical assessment and X-ray are important for reaching an accurate diagnosis.
Does hallux rigidus get worse over time?
In most cases, hallux rigidus is a progressive condition. Without treatment, the cartilage continues to wear down, and symptoms tend to worsen. The rate of progression varies between individuals. Early intervention with appropriate footwear, orthotics, and physiotherapy can slow progression and significantly reduce symptoms.8
Will a bunion go away without surgery?
No. A bunion is a structural deformity that cannot be resolved without surgery. Non-surgical treatments such as wider footwear, orthotics, and physiotherapy can relieve symptoms and slow progression, but they cannot realign the bone. Surgery is only recommended when conservative management has failed, and the deformity is affecting daily life.
What is the difference between hallux limitus and hallux rigidus?
Hallux limitus and hallux rigidus are different conditions. Hallux limitus is caused by a tethered tendon, where movement in the joint is reduced, and the big toe joint not damaged or arthritic. Hallux rigidus describes an arthritic condition, where movement is severely restricted, and pain can occur at rest. An earlier diagnosis in both conditions means that more conservative treatment options are available. If surgery is required, they both will benefit from very different surgical procedures, hence the importance of diagnosing the condition accurately.
Do I need a GP referral to see a foot and ankle specialist in London?
No. Mr Malagelada accepts direct self-referral appointments, so you do not need to see your GP first. If you have private medical insurance, most policies cover a referral to a consultant without requiring a GP letter, but it is worth checking with your insurer before booking. If you do not have medical insurance you can self-pay for your treatment and consultations with Mr Malagelada. Financing options are available for surgery fees.
Book a private consultation in London
If you are living with unexplained big toe pain, stiffness, or a visible lump on your foot, a private consultation with Mr Francesc Malagelada can give you an accurate diagnosis and a clear plan of action.
Mr Malagelada is a fellowship-trained consultant orthopaedic surgeon with a PhD in minimally invasive foot surgery. He holds a 4.99 out of 5 rating on Doctify from over 200 verified patient reviews. Appointments with Mr Malagelada are available at The Shard (London Bridge), Cromwell Hospital (Kensington), HCA 31 Old Broad Street (the City), and OneWelbeck (Mayfair). No GP referral is required. Book your appointment at footankletreatments.co.uk/contact or call 020 8629 0932