What causes the bump on top of my big toe joint?

hallux limitus

In this post I will discuss the ‘bump’ some people have on top of their big toe joint.  Many people are aware of the bump some people have along side of the big toe joint, as it goes by the name of a ‘bunion’. What is less known is the cause and treatment of a bump on top of the big toe joint, which is something somewhat different than a bunion.

Firstly, I would like to apologize for taking so long in between posts this past month.  In between very long days in the office, as well as more recently a number of hours spent helping coach my son’s football team, my spare time to post has been limited.  Now that I have more time, I can continue to post articles I hope everyone finds informative.

Back to the topic at hand.  As I wrote above, the cause and treatment of a bump on top of the big toe joint is different than what is traditionally known as a bunion.  Not to confuse things further, but this condition is commonly called a dorsal bunion by physicians, and can actually be seen with a traditional bunion at the same time. However, it’s cause really is from a somewhat different process than the traditional bunion (see the other bunion article on my site for a more detailed explanation of a bunion).

The bump commonly felt on top of the big toe joint is usually due to jamming of that joint from an arthritic process. Arthritis of the big toe joint develops over time due to a number of reasons. Usually, there is some structural abnormality in the base of that joint that allows excessive and premature wear and tear of the joint cartilage. This can include a bone that is too long, too short, angled too high, or angled too low. The motion of the big toe joint becomes reduced over time due to this wear. The reduction in motion of the joint and excessive compression force on top of the joint from it trying to force lost motion causes bone spurring to form. This usually occurs on top of the head of the 1st metatarsal, which is the long bone that forms the base of the big toe joint. The spurs become painful as inflammation develops in the joint below, and also in the tissue that covers the spurs above. What is felt externally is the painful enlargement of the spur below, which is also irritated by pressure from shoes.

Treatment of this condition usually involves surgery, although a steroid injection or anti-inflammatory medication can provide temporary relief. The surgery can be as simple as shaving the spurs down. Unfortunately, this does not correct the underlying structural problem and over time the spurs can reform. What is often needed is a procedure that alters the abnormal bone position, decompresses the joint, and repairs the joint arthritis. There are numerous procedures that accomplish this. Some severe cases of arthritis need a procedure that replaces the joint with an artificial one, or fuses it all together.

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