The great toe has a single interphalangeal joint (unlike the lesser toes, which have two), with flexor hallucis longus inserting on the plantar base of the distal phalanx and extensor hallucis longus on its dorsal base. A small interphalangeal sesamoid may be present in the plantar plate or FHL tendon at this level in some people. The joint helps the toe press firmly against the ground during push-off.
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Hallux IP joint arthritis from gout or degenerative change produces great toe IP pain managed with padding, footwear change and injection. When needed, IP arthrodesis provides reliable pain relief; the joint is fused in neutral or slight flexion so the toe still contacts the floor, usually with a single axial screw.
Great toe IP joint degeneration or gout producing IP joint pain managed conservatively with padding and injection.
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