Big toe pain
It is not unusual for people with big toe pain, swelling, and redness to assume that they have a bunion. Often, what people self-diagnose as a bunion turns out to be another ailment.
One of the conditions that people mistake for a bunion is gout, perhaps because gout does not have the top-of-mind awareness that other big toe pain-causing conditions — such as osteoarthritis and bursitis — have.
Symptoms of gout vs. bunions
There are some similarities between the symptoms of gout and bunions that might lead you to think you have one when you actually have the other.
- Joint pain. Although gout commonly affects your big toe joint, it can also affect other joints.
- Swelling. With gout, your joint will typically display the standard signs of inflammation: swelling, redness, tenderness, and warmth.
- Motion. Moving your joints normally can become difficult as gout progresses.
- Big toe joint pain. Intermittent or persistent joint pain in the big toe can be a symptom of bunions.
- Bump. With bunions, a protruding bump typically bulges from the outside of the base of your big toe.
- Swelling. The area around your big toe joint will usually be red, sore and swollen.
- Calluses or corns. These can develop where the first and second toes overlap.
- Motion. Movement of your big toe might become difficult or painful.
Causes of gout vs. bunions
Gout is an accumulation of urate crystals in any one (or more) of your joints. Urate crystals can form when you have high levels of uric acid in your blood.
If your body is producing too much uric acid or your kidneys are not able to process it properly, it can build up. As uric acid builds up, your body can form sharp, needle-shaped urate crystals that can cause joint pain and inflammation.
A bunion is a bump on the joint at the base of your big toe. If your big toe is pushing against your second toe, it can force the joint of your big toe to grow and stick out with a bunion.
There is not a consensus in the medical community as to the exact cause of how bunions develop, but factors might include:
- congenital (at birth) deformity
Some experts believe that bunion development might be caused by ill-fitting too-narrow or high-heeled shoes. Others believe that footwear contributes to, but does not cause, bunion development.
Diagnosis of gout vs. bunions
To diagnose gout, your doctor might use one of these methods:
- blood test
- joint fluid test
- urine test
Your doctor can most likely diagnose a bunion with just an examination of your foot. They might also order an X-ray to help determine the bunion’s severity and its cause.
To treat your gout, your doctor might recommend medication such as:
- nonsteroidal anti-inflammatory drug (NSAID) therapy, such as naproxen sodium (Aleve), ibuprofen (Advil, Motrin), or indomethacin (Indocin)
- Coxib therapy, such as celecoxib (Celebrex)
- colchicine (Colcrys, Mitigare)
- corticosteroids, such as prednisone
- xanthine oxidase inhibitors (XOIs), such as febuxostat (Uloric) and allopurinol (Aloprim, Lopurin, Zyloprim)
- uricosurics, such as lesinurad (Zurampic) and probenecid (Probalan)
Your doctor might also recommend lifestyle changes such as:
- regular exercise
- weight loss
- dietary adjustments such as limiting the consumption of red meat, seafood, alcoholic beverages and drinks sweetened with fructose
When treating bunions, to avoid surgery, doctors often start with conservative treatment methods such as:
- applying ice packs to relieve inflammation and soreness
- using over-the-counter bunion pads to relieve pressure from footwear
- taping to hold your foot in a normal position for pain and stress relief
- taking over-the-counter painkillers, such as acetaminophen (Tylenol) or an NSAID such as ibuprofen (Advil, Motrin) or naproxen sodium (Aleve) to help control associated pain
- using shoe inserts (orthotics) to reduce symptoms by helping to distribute pressure evenly
- wearing shoes that have plenty of room for your toes
Surgical options include:
- removing tissue from around your big toe joint area
- removing bone to straighten your big toe
- realigning the bone that runs between your big toe and the back part of your foot to fix your big toe joint’s abnormal angle
- permanently joining the bones of your big toe joint
Assessing the difference between gout and a bunion can be tricky for the untrained eye.
While gout is a systemic condition, a bunion is a localized toe deformity. Overall, both are treated differently.
If you have persistent pain and swelling in your big toe or notice a bump on your big toe joint, make an appointment with your doctor. They will let you know if you have gout or a bunion or another condition.