Gout or Bunions for Arthritis Sufferers

Gout or Bunions for Arthritis Sufferers describes differences between bunions and gout. So if you have a painful big toe, you can see if it is gout or not.

Gout or Bunions Audience

I wrote Gout or Bunions for GoutPal Arthritis Sufferers. Because they need to consider if they have gout or a different type of arthritis. So if you’re not sure which type of gout sufferer you are, please read Questions for Gout Sufferers.

Difference between Gout and Bunion

In a nutshell, gout is caused by our immune system reacting to an “invasion” of uric acid crystals. Whereas a bunion is our bodies attempt to repair damage caused by physical pressure.

Gout can affect any joint. But it frequently starts in the big toe. Because that is a large joint that is often colder and at the lowest point. So a combination of gravity, slower blood flow, and lower temperature make the big toe first joint the most likely place for gout to start in most people. However, this is heavily influenced by personal habits. For instance, I got gout in my ankle first because my job entailed a lot of driving. Another common characteristic of gout is that it strikes without warning. Then you reach maximum pain within a day. Followed by a week or two of gradual lessening pain.

Comparing gout with bunions, we see a different profile. Because bunions only affect the big toe. But the little toe can also be similarly affected by what is called a bunionette, or tailor’s bunion. Bunion pain is usually progressive over several days or weeks. Also, it often starts with the big toe bending upwards or towards the second toe.

The main reason why bunions are confused with gout is that both can have red skin and painful swelling. But before we consider the best way to tell them apart, let’s look at other big toe problems.

Other causes of Swollen Big Toe

As well as bunion, gout has been confused with several diseases that cause big toe pain.[1]. Here Chou and colleagues list:

  • Hallux rigidus – osteoarthritis of the big toe, literally Stiff Big Toe.
  • Hallux valgus – bunion, as I describe above.
  • Sesamoiditis – inflammation of a sesamoid bone, normally in the foot.
  • Stress fractures – caused by injury from activities or physical contact with hard objects.

Also, they consider general bone and cartilage defects. As well as gout.

Stress fractures, osteochondral defects, and gout are other causes of toe pain. X-rays are essential for accurate diagnosis. Nonoperative measures can reduce pain, but surgery is an option for recalcitrant cases.

Later, Zanni and colleagues extend the list[2]:

Common mechanical problems include hammertoe, arthritis, bunions, and metatarsalgia. Disease-induced conditions include onychomycosis, athlete’s foot, plantar warts, gout, and diabetes. Treatment is case-specific and often involves multiple interventions, including lifestyle changes.

Does your big toe have gout, bunion, or both?

Your Gout or Bunions

If you have a red, swollen big toe, you need to find out if it is bunion, gout, or some other form of arthritis. Because, as these studies show, treatment is very different depending on what you are actually suffering from. So Chou recommends x-rays. But if gout is suspected, I suggest a uric acid blood test is essential. Also, if possible, you should get a rheumatologist to draw fluid from the affected joint. Because the presence of uric acid crystals is a definitive test for gout. But an absence of crystals does not rule out gout.

Finally, you might find that you suffer from both gout and bunion. Because swelling from gouty tophi can cause pressure on the joint leading to a bunion. However, if uric acid is treated successfully, that might resolve the bunion problem at the same time.

In conclusion, whenever gout diagnosis is doubtful, you should consult a rheumatologist. Because there are several tests that can differentiate between different causes of a swollen red big toe. But most of these tests are not suitable for primary care physicians.

If you are still not sure what to do next, ask fellow sufferers about your swollen red toes.

Gout or Bunions References

  1. Chou, Loretta B. “Disorders of the first metatarsophalangeal joint: Diagnosis of great-toe pain.” The physician and sportsmedicine 28, no. 7 (2000): 32-45.
  2. Zanni, Guido, and Jeannette Wick. “Delving into foot mechanics and related problems.” The Consultant Pharmacist® 26, no. 12 (2011): 890-901.
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Medical Disclaimer: The pupose of GoutPal is to provide jargon-free explanations of medical gout-related terms and procedures. Because gout sufferers need to know what questions to ask their doctor. Also, you need to understand what your doctor tells you. So this website explains gout science. But it is definitely NOT a substitute for medical advice.

Information on this website is provided by a fellow gout sufferer (Keith Taylor) with an accountant's precision for accurate data. But no medical qualifications. So you must seek professional medical advice about gout and any other health matters.

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