Bunion vs. Gout: Identification, Pain, and Diagnosis

When bunions or gout affect the big toe, symptoms can be similar. Both conditions can cause pain, swelling, and redness of the big toe and lead to discomfort with walking.

Bunions and gout are often mistaken for each other. What people self-diagnose as a bunion is instead a more severe condition. While gout and bunions share similarities, they differ in what causes them and how they are treated. 

This article covers the similarities and differences between bunions and gout, including causes, diagnosis, and treatment.

Major Differences Between Bunion and Gout

Bunions and gout differ in many ways, and the first significant difference is the nature of the conditions.

Bunions are localized to the foot, and gout is a systemic (body-wide) problem in which the body produces too much uric acid. Bunion care and prevention will emphasize foot health, while gout care and treatment focus on managing uric levels in the body and treating gout attacks.

Additional distinctions between the conditions include appearance and location, sensation, and causes.

Location and Onset

A bunion is a bony bump that forms at the metatarsophalangeal (MTP) joint—the area where the big toe meets the foot. A bunion will develop slowly until it gets bigger and sticks out, making the big toe turn inward.

When gout strikes the big toe, it often affects the MTP joint. Gout can also affect other joints, including the elbows, ankles, wrists, fingers, and knees, but the big toe is most often the site of a gout attack.

Gout is characterized by periods of flare-ups (also called gout attacks) and remission (times of few if any symptoms). Most people will experience repeated gout episodes for their entire lives. For some, the condition will be chronic and lead to joint damage.

Sensation

The medical term for a bunion is "hallux valgus." This condition can change the typical structure of the MTP joint, causing it to shift out of place. There can be severe pain at the bump and in the area where the toe leans toward the second toe.

With a bunion, there will also be pain, swelling, and redness in the toe joint, which can worsen when wearing shoes or when walking. Callus (thick, hard skin layer) formation might occur where the big toe rubs against the second toe.

Gout attacks can be excruciating. Even something as light as a bed sheet touching the big toe can cause severe pain. The toe will feel very hot and tender, and there will be swelling in and around the affected joint. The gout attack can subside in hours or days, with or without treatment. For some people, gout flares can last several weeks.

Causes 

Some researchers believe bunions are genetic and occur because of foot structure problems, which are often inherited. Inherited foot problems that might contribute to bunions include flat feet, flexible ligaments, and abnormal bone structure.

Some researchers have suggested that improperly fitting shoes might contribute to bunions, while others disagree and suggest shoes might worsen already existing foot problems.

Gout is caused by hyperuricemia (high uric acid levels in the body). The body will make uric acid when it breaks down purines, which are produced in the body or come from purine-rich foods and beverages, such as fatty meats, organ meats, some seafood types such as shrimp and tuna, and alcoholic beverages.

Some risk factors make it more likely for you to develop gout. Risk factors for gout include being male, having a high body mass index (BMI), having certain health conditions (i.e., high blood pressure or diabetes), using water pills, and consuming foods or drinks high in fructose syrups or purines.

Getting a Diagnosis

Some methods for diagnosing gout are similar to diagnostic methods for bunions. But a gout diagnosis requires more testing to confirm the condition and rule out other conditions that cause similar symptoms. 

Gout

Gout is typically diagnosed after an initial attack of gout symptoms. A healthcare provider will want to know about your medical and symptom history and if other family members have had gout attacks or other arthritis conditions.

The healthcare provider will also examine the affected toe and may request additional testing to confirm a diagnosis or rule out other conditions.

Testing for gout may include lab work and imaging, such as:

• Uric acid blood test: This test can help determine if you have high uric acid levels. High uric acid levels are associated with gout, but it is possible to have high levels and not have gout. 
• Joint aspiration: The test involves removing a fluid sample of the affected joint and examining it under a microscope to look for urate crystals and other abnormalities. Gout occurs when urate crystals accumulate in a joint. They are the result of high levels of uric acid in the blood.
• Imaging: X-rays can look for joint disease or tophi (urate crystal lumps) under the skin. Ultrasound is sensitive enough to detect urate crystals in an affected joint.
  

Bunion 

A bunion diagnosis can easily be made by physical examination of the toe. The healthcare provider might move the toe back and forth during the exam to check for any limits in the toe's movements.

They might request an X-ray to determine if you have an injury or deformity. Blood work is only done if autoimmune arthritis is suspected. 

Therapeutic Relief and Treatment

Because gout and bunions have very different causes, their treatment options will vary and some may overlap. 

Gout

Treatment for gout focuses on managing gout attacks and preventing future attacks. A treatment plan typically includes home remedies and prescription medications.

During a Gout Attack

You can take an over-the-counter (OTC) nonsteroidal anti-inflammatory drug (NSAID) like Aleve (naproxen) or Advil (ibuprofen) to help bring down inflammation and alleviate pain. Elevating the foot and applying ice can also help to ease swelling and pain.

Avoid sugary drinks and alcohol during a gout attack. Drink plenty of water. 

You may choose to use a cane or other mobility device when walking to keep pressure off the toe. Consider wearing open-toe shoes or sandals or even cutting a hole in a sock so the toe is out and there is no pressure on it.

Your healthcare provider can prescribe medications to reduce inflammation and swelling and alleviate pain during a gout attack. Medicines usually prescribed to manage gout attacks include Colcrys (colchicine) and corticosteroids. 

Long-Term Management 

Your healthcare provider might suggest lifestyle changes and prescription medicines to prevent future gout attacks.

The Centers for Disease Control and Prevention (CDC) recommends the following lifestyle modifications for managing gout long-term:

• Reducing your alcohol intake 
• Avoiding sugary beverages 
• Exercising regularly
• Maintaining a healthy weight 
• Avoiding purine-rich foods
  

Your healthcare provider may also prescribe medications like Zyloprim (allopurinol) to reduce uric acid levels and prevent future gout attacks. For cases in which these don't work, Krystexxa (pegloticase) is an intravenous infusion that may be given.

Bunion 

Bunions usually are treated with nonsurgical options. Surgery is considered when nonsurgical options have not helped you.

Nonsurgical treatment for bunions includes: 

• Wearing shoes with padded soles that provide enough wiggle room for toes 
• Taping your foot into a normal position to reduce pressure off the bunion
• Taking an over-the-counter NSAID to relieve pain and swelling 
• Wearing arch supports in your shoes 
  

Surgery is recommended for people who have run out of nonsurgical options for treating a bunion. A bunionectomy is the most common procedure used to treat a bunion. It involves correcting the position of the big toe and removing swollen tissue from the affected joint. Full recovery from a bunionectomy can take up to eight weeks. 

Summary 

Bunions and gout are painful conditions affecting the big toe's metatarsophalangeal joint. Both cause pain, swelling, and severe discomfort with walking and putting pressure on the big toe. 

While these conditions share similar symptoms, they have different causes and must be managed differently. A bunion occurs because of foot structure abnormalities, while gout is caused by high uric acid levels in the body. 

Treatment for gout focuses on treating and preventing gout attacks with medication and lifestyle changes. Bunion pain is treated with NSAIDs and therapies that alleviate stress on the big toe. A bunion can be treated with surgery if nonsurgical treatments have not helped or the toe becomes deformed. 

A Word From Verywell

Numerous conditions can affect the MTP joint at the base of the big toe. Examples other than bunions and gout include other types of inflammatory arthritis, turf toe (an injury to the base of the big toe), hammertoe (a bent toe), infections, and metatarsal fractures (a break or hairline crack in the bone). 

If you experience MTP pain, reach out to a healthcare provider. If you experience redness, warmth, sudden swelling, or severe pain of the toe, you should seek immediate medical attention to rule out infection or a fracture.