There's several things it could be:

~ Gout - though this might have shown on an xray but you'd need a blood test to confirm. Gout is generally treated with things like allopurinol.
~ arthritis - again, xray would have shown but early stages might be missed. Depends who ordered and read them. Treatment can include surgery to fuse the joint or even an artificial, silicone joint
~ soft tissue inflammation - from the fat pad down to where the tendon inserts into the bone. Very common, actually. They are generally self-limiting, meaning they will settle over time but it persistent an injection of cortisone can hurry the healing on
~ some trauma - what your chap described as a 'bone bruise'! Again will settle in time but an injection can help hurry it along.
~ callosities or corn which can easily be dealt with by a chiropodist.

Metatarsalgia does not manifest in the great toe, more usually on the metatarsal heads of the smaller toes. It is caused by poor or extreme weight bearing on those m/t heads, often from over-use of high heels or too much walking or the presence of callouses.