Big toe arthritis (hallux rigidus)

Big toe arthritis or hallux rigidus is when your big toe becomes arthritic at the metatarsophalangeal (MTP) joint. Hallux refers to the big toe and rigidus means rigid or stiff. Big toe arthritis can affect one or both feet.

What causes it?

It may be caused by wear and tear in the joint or repetitive strain injury, but in many cases no definite reason can be found and it’s not normally associated with generalised arthritis. It is most common in people in their 30’s and 40’s. People often live with the condition for many years before seeking medical help, while pain and stiffness gradually increase.

What are the symptoms?

Symptoms usually include pain and stiffness around the big toe joint, especially as the toe bends upwards. There can also be a noticeable bump, often on the top of the joint, causing your shoes to rub, and you may have pain when you walk or play sports.

Can it become worse?

People often put up with the symptoms for many years before seeking medical attention. If you decide not to see your doctor, the problem will tend to become slowly worse, with stiffness increasing. It can be treated at any stage; however, early surgery can preserve the joint whereas later surgery may require toe fusion.

How is it diagnosed?

A medical examination to discuss your symptoms and range of movement may be backed up by an X-ray to examine the extent of the arthritis.

How is it treated?

  • Non-operative treatment: you may be offered specially made insoles to relieve the pressure in the big toe joint, or wear stiff or rocker-bottom shoes which are more supportive for your toe, ensuring adequate space in the shoe. Your doctor may also suggest taking painkillers or anti-inflammatory tablets
  • Surgery: if the bump on the joint (dorsal osteophyte or bone spur) is stopping the toe from bending upwards, it can be surgically removed (as a day case procedure) to improve the range of movement and relieve pain using a procedure called cheilectomy
  • The joint can be tidied (debridement), removing the arthritic joint surface, and in some cases toe fusion surgery may be carried out using a small plate and screws to leave a stiff but pain-free joint which does not normally cause problems with walking or fitting shoes
  • Big toe joint replacement surgery can be performed if you are concerned about losing your range of movement. However, not every case is suitable for joint replacement, so this is something you should discuss with your surgeon
  • Is joint replacement better than joint fusion?

Although the joint is permanently stiffened in toe fusion, the toe is fixed in a position that allows patients to carry on with sport, even jogging and running and you will still be able to wear shoes with moderate heels if you wish. Joint replacement is a better option for some people, for example if you prefer to wear a higher heel. It can also maintain or improve your range of movement.

Important: This information is only a guideline to help you understand your treatment and what to expect. Everyone is different and your rehabilitation may be quicker or slower than other people’s. Please contact us for advice if you’re worried about any aspect of your health or recovery.