Table of ContentsView AllTable of ContentsWhat It IsSymptomsCausesDiagnosisTreatmentPhysical TherapySurgeriesOutlookSummary
Table of ContentsView All
View All
Table of Contents
What It Is
Symptoms
Causes
Diagnosis
Treatment
Physical Therapy
Surgeries
Outlook
Summary
Hallux rigidus is a type of arthritis affecting the big toe’smetatarsophalangeal(MTP) jointwhere the big toe meets the foot. It is one of the most common arthritic conditions affecting people ages 30 to 60.Hallux rigidus causes stiffness in the big toe. It can be painful and affect standing and walking.
The MTP joint experiences stress from bearing weight when standing or walking.That wear and tear can lead tocartilagedamage and hallux rigidus. Cartilage is a connective tissue that acts as a protective cushion and shock absorber for the joints and bones. Other inflammatory disorders can also lead to arthritis in the toes, especially the big toe.
Hallux rigidus can be managed with nonsurgical measures, including anti-inflammatory pain relievers and wearing comfortable shoes. Surgery might be considered for people who experience severe pain that affects their mobility and ability to participate in daily activities.
This article will explain hallux rigidus, its causes and symptoms, treatment, and more.
AzmanJaka / Getty Images
What Is Hallux Rigidus Exactly?
Your big toe has two joints, and the MTP joint is the bigger of the two. The function of the MTP joint is to bend and grip the floor to offer foot flexibility with walking.
Hallux rigidus is sometimes considered a type ofosteoarthritis(wear-and-tear arthritis). Research shows up to 10% of adults have symptomatic hallux rigidus.However, evidence of it can be seen on imaging in 20% to 48% of adults over age 40. When there are symptoms, the condition can be quite painful and affect overall health and well-being.
This condition causes pain and stiffness of the MTP joint. Over time, it gets harder to bend the toe. It is a progressive condition in which the big toe’s motion will decrease over time. As hallux rigidus advances, the big toe will become completely stiff, and movement will be impossible.
Hallux limitusis sometimes confused with hallux rigidus. Both conditions affect the big toe, cause stiffness and swelling, and make walking uncomfortable. Hallux limitus can advance into hallux rigidus, when the joint cannot move at all, and walking is painful or near impossible due to pain and the inability to bear weight on the joint.
4 Common Conditions That Affect Your Toes
Stiff Big Toe Stages
Hallux rigidus is sometimes classified in stages from 0 to 4. Each grade is based on how much the condition affects your ability to move the big toe.
Hallux rigidus stages are:
What Are the Symptoms of Hallux Rigidus?
Symptoms of hallux rigidus can vary from person to person and will worsen over time.
Symptoms might include:
Because hallux rigidus is aprogressive condition(one that worsens over time), you may experience additional symptoms due to cystic bone changes and joint damage.
Symptoms of cystic bone changes and bone or joint damage related to hallux rigidus include:
What Causes Hallux Rigidus?
What causes hallux rigidus is not well understood. Researchers believe trauma is the leading cause of hallux rigidus affecting only one toe.Bilateral involvement (affecting both big toes) might be linked to family history and female sex.
Degenerative changes over time or repetitive stress might also cause someone to develop hallux rigidus.Toe and foot structureand certain medical conditions are also believed to be linked to the condition, including:
How Is Hallux Rigidus Diagnosed?
If you have problems bending your toe or walking because you are experiencing big toe pain, it is crucial to see a healthcare provider as soon as possible.
Hallux rigidus is easier to treat in its early stages. If you wait until you see a bony bump at the top of the toe, bone spurs will have already formed, and treatment may need to be more aggressive.
The first step in diagnosing hallux rigidus is the physical exam. A healthcare provider will examine your foot to look for bone spurs. They will also move your toe around to determine what movements cause pain and how deep that pain is.This can help determine the severity and the best treatment for your hallux rigidus.
Your healthcare provider may also request X-rays of your foot and toe. X-rays can help identify bone spurs, the severity of arthritis, joint space narrowing, and cartilage loss.
Your healthcare provider might refer you to apodiatristfor further treatment. A podiatrist is a doctor who specializes in diagnosing and treating foot conditions. Seeing a podiatrist can allow for better assessment and treatment of foot problems like hallux rigidus.
Why Does the Bottom of My Foot Hurt When I Walk?
Can Hallux Rigidus Be Treated at Home?
The treatment your healthcare provider recommends for hallux rigidus will depend on the cause and severity of the symptoms. While there is no one best treatment for hallux rigidus, a combination of therapies can help manage pain and other symptoms.
A healthcare provider might recommend one or more of the following treatments to manage symptoms and keep the condition from worsening.
Footwear Changes
Wearing shoes with plenty of room for your toes can reduce pressure on the MTP joint. You will want to avoid high heels and consider shoes with stiff soles.
Orthotics are prescription medical devices placed inside your shoes to correct foot problems, including those that affect walking and standing.
How to Find Shoes That Fit Your Toes
You will want to avoid activities that stress your big toe joint. This might include playing sports or repetitive on-the-job tasks. Your healthcare provider can also recommendgel pad toe supportslike those used forbunioncare, as well as splints to support the big toe and limit movement.
OTC Pain Relievers
Your healthcare provider might suggest over-the-counter (OTC) pain relievers to manage symptoms of hallux rigidus. Your options include various oral and topicalnon-steroidal anti-inflammatory drugs(NSAIDs) such as Advil (ibuprofen) or Aleve (naproxen) to ease pain and reduce swelling.
Cold Therapy
Applying ice or a cold pack to the affected big toe can relieve pain and reduce swelling. Wrap the ice or cold pack in a thin towel to avoid placing the ice directly on your skin.
Foot Soaks
Acontrast bath(foot soak) might help to reduce inflammation in your big toe. It alternates hot and cold, which means you will need two buckets of water—one warm to comfortably hot and the other cold.
The American Academy of Orthopaedic Surgeons recommends you soak in cold water for 30 seconds, then switch to warm water for 30 seconds.Continue to switch for at least five minutes, ending at the cold one. You can do this foot soak up to three times a day.
You will want to avoid extreme hot and cold temperatures, especially if your feet are sensitive to one temperature or both.
Self-Care Tips to Soothe Aching Feet at Home
Prescription Injections
Injections in the MTP joint of the toe can temporarily relieve pain and swelling. Bothcorticosteroidandhyaluronic acid injectionsmight offer relief.
However, the Food and Drug Administration (FDA) has not approved hyaluronic acid injections for injection in the first MTP joint.Such use is considered off-label (unapproved use of an approved drug). This use has typically been confirmed with rigorous clinical study, but there is no FDA approval.Approval might be pending or upcoming at a later time, and the FDA is aware of its benefits and risks.
Corticosteroid injections have been found to help people with mild arthritis, but their effectiveness for severe arthritis is limited.Some research on hyaluronic acid injections shows them as being far superior to steroid injections in managing arthritis symptoms, reducing pain, and improving function.
Physical therapymight help manage hallux rigidus. It can help reduce pain, improve the toe joint’s motion, and strengthen the muscles in the foot.
Aphysical therapistcan recommend interventions to help you manage hallux rigidus.
Therapies might include:
Surgeries for Hallux Rigidus
If nonsurgical treatments cannot manage symptoms and pain or if you lose function in the MTP joint, your healthcare provider might recommend surgery. They will share your options with you and help you decide based on how severe the hallux rigidus is. Surgery is the only way to get rid of hallux rigidus.
Cheilectomy
Cheilectomysurgerycan treat mild to moderate damage.A cheilectomy is sometimes done in combination with anosteotomy.The cheilectomy is done to shave bone spurs, while the osteotomy cuts bone to change the big toe’s position and relieve pressure off the top of the joint.
Studies on cheilectomy show it results in good outcomes, especially in the condition’s early stages of hallux rigidus.Cheilectomy might be less successful in later stages.
Interposition Arthroplasty
Interposition arthroplasty can treat moderate to severe hallux rigidus.It can eliminate the need for a joint replacement or fusion surgery. Interposition arthroplasty involves removing damaged bone and putting a spacer between the bones to reduce bone contact.
This surgical option has been found effective for moderate to severe hallux rigidus.It can be helpful for people who want to maintain their range of motion of the big toe.
Arthrodesis
Arthrodesissurgeryis recommended if damage to the big toe is severe. It involves removing damaged cartilage and using pins and screws to place the joint into a permanent position.
The fused bone will grow together slowly, eliminating the toe joint, which means you cannot bend the toe. Even so, it is the most helpful way to reduce pain in severe hallux rigidus for some people.
Arthrodesis is considered in cases in which a cheilectomy has failed. Overall satisfaction will arthrodesis is more than 90%.
Arthroplasty
Arthroplastyis joint replacement surgery. It involves replacing damaged joint parts with artificial parts made of plastic or metal.This surgery might help relieve hallux rigidus symptoms while maintaining your range of motion. Arthroplasty is not often used to manage hallux rigidus because implant failure is high.
What’s the Outlook for Stiff Big Toe?
Hallux rigidus is a progressive condition that will get worse over time. Nonsurgical treatments can manage symptoms, reduce pain, and slow down progression.
Surgery may be needed if nonsurgical therapies no longer offer relief. Some surgical procedures might minimize the ability to bend the toe, but they help you to walk and be active without pain and discomfort.
For example, cheilectomy has a high success rates for people in the early stages of hallux rigidus, and arthrodesis is considered the gold standard surgical procedure for end-stage hallux rigidus.
Hallux rigidus is a type of arthritis affecting the MTP joint at the base of the big toe. It causes pain and stiffness. Because it is a progressive condition, it will eventually affect the ability to bend the big toe. The condition is sometimes measured in stages based on the symptoms and effects on the joint, including the growth of bone spurs and joint space narrowing.
Causes of hallux rigidus include trauma and osteoarthritis. If hallux rigidus runs in your family or you have a structural problem in your foot, you are more likely to develop the condition. People in certain occupations requiring repetitive movements of the MTP joints are also at a higher risk.
The symptoms of hallux rigidus can be managed with nonsurgical treatments. Some of these therapies might slow down progression. Ways to manage hallux rigidus nonsurgically include physical therapy, injections, OTC pain relievers, wearing appropriate footwear, and avoiding activities that can worsen the condition.
If hallux rigidus worsens and you experience damage to the MTP joint, your healthcare provider might recommend surgery to fix the damaged bone. The type of surgery recommended is dependent on the severity of the condition. Surgery might also help you become active again, although you may lose the ability to bend the toe in some cases.
12 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Hallux rigidus (stiff big toe).American Academy of Orthopaedic Surgeons.Arthritis of the foot and ankle.Anderson MR, Ho BS, Baumhauer JF.Republication of “Current concepts review: hallux rigidus.“Foot Ankle Orthop. 2023;8(3):24730114231188123. doi:10.1177/24730114231188123Lam A, Chan JJ, Surace MF, Vulcano E.Hallux rigidus: How do I approach it?.World J Orthop. 2017;8(5):364-371. doi:10.5312/wjo.v8.i5.364Puszczałowska-Lizis E, Dąbrowiecki D, Jandziś S, Żak M.Foot deformities in women are associated with wearing high-heeled shoes.Med Sci Monit. 2019;25:7746-7754. doi:10.12659/MSM.917983Evan Mah Bs (Kin), Brent Burbridge M.Degenerative joint diseases – hip. Undergraduate Diagnostic Imaging Fundamentals.Roddy E, Muller S, Rome K, et al.Foot problems in people with gout in primary care: baseline findings from a prospective cohort study.J Foot Ankle Res. 2015;8:31. doi:10.1186/s13047-015-0090-9American Academy of Orthopaedic Surgeons.Orthotics.Food and Drug Administration.Understanding unapproved use of approved drugs “off label.“Stevens J, de Bot RTAL, Witlox AM, et al.Long-term effects of cheilectomy, Keller’s arthroplasty, and arthrodesis for symptomatic hallux rigidus on patient-reported and radiologic outcome.Foot Ankle Int. 2020;41(7):775-783. doi:10.1177/10711007209196811. Shields J, Gambhir N, Alben M, Kogan A, Greenberg P, Delmonte R.Cheilectomy with decompression osteotomy for treatment of Hallux limitus and rigidus: A retrospective study with 5-year outcomes.J Foot Ankle Surg. 2023;62(2):282-285. doi:10.1053/j.jfas.2022.07.008.Patel HA, Kalra R, Johnson JL, et al.Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? - A systematic review and meta-analysis.Foot Ankle Surg. 2019;25(5):571-579. doi:10.1016/j.fas.2018.07.006
12 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Academy of Orthopaedic Surgeons.Hallux rigidus (stiff big toe).American Academy of Orthopaedic Surgeons.Arthritis of the foot and ankle.Anderson MR, Ho BS, Baumhauer JF.Republication of “Current concepts review: hallux rigidus.“Foot Ankle Orthop. 2023;8(3):24730114231188123. doi:10.1177/24730114231188123Lam A, Chan JJ, Surace MF, Vulcano E.Hallux rigidus: How do I approach it?.World J Orthop. 2017;8(5):364-371. doi:10.5312/wjo.v8.i5.364Puszczałowska-Lizis E, Dąbrowiecki D, Jandziś S, Żak M.Foot deformities in women are associated with wearing high-heeled shoes.Med Sci Monit. 2019;25:7746-7754. doi:10.12659/MSM.917983Evan Mah Bs (Kin), Brent Burbridge M.Degenerative joint diseases – hip. Undergraduate Diagnostic Imaging Fundamentals.Roddy E, Muller S, Rome K, et al.Foot problems in people with gout in primary care: baseline findings from a prospective cohort study.J Foot Ankle Res. 2015;8:31. doi:10.1186/s13047-015-0090-9American Academy of Orthopaedic Surgeons.Orthotics.Food and Drug Administration.Understanding unapproved use of approved drugs “off label.“Stevens J, de Bot RTAL, Witlox AM, et al.Long-term effects of cheilectomy, Keller’s arthroplasty, and arthrodesis for symptomatic hallux rigidus on patient-reported and radiologic outcome.Foot Ankle Int. 2020;41(7):775-783. doi:10.1177/10711007209196811. Shields J, Gambhir N, Alben M, Kogan A, Greenberg P, Delmonte R.Cheilectomy with decompression osteotomy for treatment of Hallux limitus and rigidus: A retrospective study with 5-year outcomes.J Foot Ankle Surg. 2023;62(2):282-285. doi:10.1053/j.jfas.2022.07.008.Patel HA, Kalra R, Johnson JL, et al.Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? - A systematic review and meta-analysis.Foot Ankle Surg. 2019;25(5):571-579. doi:10.1016/j.fas.2018.07.006
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Academy of Orthopaedic Surgeons.Hallux rigidus (stiff big toe).American Academy of Orthopaedic Surgeons.Arthritis of the foot and ankle.Anderson MR, Ho BS, Baumhauer JF.Republication of “Current concepts review: hallux rigidus.“Foot Ankle Orthop. 2023;8(3):24730114231188123. doi:10.1177/24730114231188123Lam A, Chan JJ, Surace MF, Vulcano E.Hallux rigidus: How do I approach it?.World J Orthop. 2017;8(5):364-371. doi:10.5312/wjo.v8.i5.364Puszczałowska-Lizis E, Dąbrowiecki D, Jandziś S, Żak M.Foot deformities in women are associated with wearing high-heeled shoes.Med Sci Monit. 2019;25:7746-7754. doi:10.12659/MSM.917983Evan Mah Bs (Kin), Brent Burbridge M.Degenerative joint diseases – hip. Undergraduate Diagnostic Imaging Fundamentals.Roddy E, Muller S, Rome K, et al.Foot problems in people with gout in primary care: baseline findings from a prospective cohort study.J Foot Ankle Res. 2015;8:31. doi:10.1186/s13047-015-0090-9American Academy of Orthopaedic Surgeons.Orthotics.Food and Drug Administration.Understanding unapproved use of approved drugs “off label.“Stevens J, de Bot RTAL, Witlox AM, et al.Long-term effects of cheilectomy, Keller’s arthroplasty, and arthrodesis for symptomatic hallux rigidus on patient-reported and radiologic outcome.Foot Ankle Int. 2020;41(7):775-783. doi:10.1177/10711007209196811. Shields J, Gambhir N, Alben M, Kogan A, Greenberg P, Delmonte R.Cheilectomy with decompression osteotomy for treatment of Hallux limitus and rigidus: A retrospective study with 5-year outcomes.J Foot Ankle Surg. 2023;62(2):282-285. doi:10.1053/j.jfas.2022.07.008.Patel HA, Kalra R, Johnson JL, et al.Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? - A systematic review and meta-analysis.Foot Ankle Surg. 2019;25(5):571-579. doi:10.1016/j.fas.2018.07.006
American Academy of Orthopaedic Surgeons.Hallux rigidus (stiff big toe).
American Academy of Orthopaedic Surgeons.Arthritis of the foot and ankle.
Anderson MR, Ho BS, Baumhauer JF.Republication of “Current concepts review: hallux rigidus.“Foot Ankle Orthop. 2023;8(3):24730114231188123. doi:10.1177/24730114231188123
Lam A, Chan JJ, Surace MF, Vulcano E.Hallux rigidus: How do I approach it?.World J Orthop. 2017;8(5):364-371. doi:10.5312/wjo.v8.i5.364
Puszczałowska-Lizis E, Dąbrowiecki D, Jandziś S, Żak M.Foot deformities in women are associated with wearing high-heeled shoes.Med Sci Monit. 2019;25:7746-7754. doi:10.12659/MSM.917983
Evan Mah Bs (Kin), Brent Burbridge M.Degenerative joint diseases – hip. Undergraduate Diagnostic Imaging Fundamentals.
Roddy E, Muller S, Rome K, et al.Foot problems in people with gout in primary care: baseline findings from a prospective cohort study.J Foot Ankle Res. 2015;8:31. doi:10.1186/s13047-015-0090-9
American Academy of Orthopaedic Surgeons.Orthotics.
Food and Drug Administration.Understanding unapproved use of approved drugs “off label.”
Stevens J, de Bot RTAL, Witlox AM, et al.Long-term effects of cheilectomy, Keller’s arthroplasty, and arthrodesis for symptomatic hallux rigidus on patient-reported and radiologic outcome.Foot Ankle Int. 2020;41(7):775-783. doi:10.1177/1071100720919681
- Shields J, Gambhir N, Alben M, Kogan A, Greenberg P, Delmonte R.Cheilectomy with decompression osteotomy for treatment of Hallux limitus and rigidus: A retrospective study with 5-year outcomes.J Foot Ankle Surg. 2023;62(2):282-285. doi:10.1053/j.jfas.2022.07.008.
Patel HA, Kalra R, Johnson JL, et al.Is interposition arthroplasty a viable option for treatment of moderate to severe hallux rigidus? - A systematic review and meta-analysis.Foot Ankle Surg. 2019;25(5):571-579. doi:10.1016/j.fas.2018.07.006
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