Hallux Rigidus: A Podiatrist’s Guide to Big Toe Arthritis

Pain and stiffness in the big toe can make everyday activities such as walking, climbing stairs and exercising surprisingly difficult. One possible cause is hallux rigidus, a form of arthritis affecting the joint at the base of the big toe.

Hallux rigidus can range from mild stiffness and discomfort to significant restriction of movement in the big toe joint. Symptoms often become more noticeable during activities that require the big toe to bend upwards, particularly during the push-off phase of walking or running.

As a podiatrist, one of the most important considerations when managing hallux rigidus is finding ways to keep people comfortable and active while reducing painful movement and pressure around the affected joint.

What Is Hallux Rigidus?

Hallux rigidus is arthritis affecting the first metatarsophalangeal joint (MTP joint) – the joint where the big toe meets the foot.

Normally, the big toe bends upwards as you move forward over your foot during walking. When arthritis develops in this joint, movement can become painful and increasingly restricted.

Changes within the joint can include deterioration of the joint surfaces and the development of bone spurs, particularly around the top of the joint.

In earlier stages, the joint may still move but have a restricted range of motion. This is sometimes referred to as hallux limitus. As the condition becomes more advanced, movement can become considerably more restricted.

What Causes Hallux Rigidus?

There isn't always one identifiable cause of hallux rigidus.

A combination of joint structure, previous injury, genetics, foot mechanics and repeated loading may contribute to the development of arthritis in the big toe joint.

Factors that may be associated with hallux rigidus include:

Foot Structure and Mechanics

The shape and mechanics of the foot can influence the way forces pass through the big toe joint during walking.

Some foot types may place greater stress through the first MTP joint, although foot mechanics vary considerably between individuals.

Previous Injury

Previous trauma to the big toe joint – including significant sprains, fractures or other joint injuries – may increase the likelihood of arthritic changes developing later.

Genetics

Hallux rigidus can sometimes occur in families. Inherited differences in foot structure and joint anatomy may contribute to an individual's susceptibility.

Repetitive Joint Loading

Activities that repeatedly load the big toe joint may aggravate symptoms in someone who already has changes within the joint.

However, this doesn't mean that activities such as running or hiking automatically cause hallux rigidus.

Osteoarthritis and Other Joint Conditions

Hallux rigidus is commonly associated with osteoarthritis, although other inflammatory or joint conditions can also cause pain and stiffness around the big toe.

If your big toe becomes suddenly red, hot, swollen and extremely painful, it's important to seek medical advice because other conditions can cause similar symptoms.

Symptoms of Hallux Rigidus

Symptoms vary depending on the severity of the condition.

Common symptoms include:

Pain around the base of the big toe

Stiffness or reduced movement in the big toe joint

Pain when the toe bends upwards

Difficulty with walking or running

Swelling around the joint

A hard or prominent bump on top of the joint

Discomfort when shoes press against the top of the toe

Changes in the way you walk to avoid bending the painful joint

Symptoms are often more noticeable during activities requiring greater movement through the big toe.

Why Does Hallux Rigidus Hurt When Walking?

During normal walking, the big toe bends upwards as your body moves over the front of the foot.

This movement is particularly important during the push-off or propulsion phase of walking.

When the first MTP joint is arthritic and stiff, this movement can become painful. People may unconsciously change the way they walk to avoid bending the big toe.

For this reason, many conservative management strategies for hallux rigidus focus on either reducing painful movement through the joint or making it easier to move over the front of the foot.

How Is Hallux Rigidus Diagnosed?

Hallux rigidus is usually assessed by examining the big toe joint and discussing your symptoms.

A podiatrist, GP or other suitably qualified health professional may assess:

Where the pain is located

How much movement is available in the big toe

Whether movement causes pain

Whether swelling or a bony prominence is present

Your footwear

How the foot functions during walking

X-rays may also be recommended to assess the joint surfaces, joint space and the presence of bone spurs or other arthritic changes.

Managing Hallux Rigidus Without Surgery

Many people with hallux rigidus begin with conservative treatment.

The most appropriate approach depends on the severity of the arthritis, the amount of movement remaining in the joint, your footwear and the activities you want to continue doing.

Choose Shoes That Don't Compress the Big Toe Joint

Footwear can make a significant difference to comfort.

Shoes with a wide and sufficiently deep toe box can reduce pressure against a prominent or sensitive big toe joint.

If a bone spur is present on top of the joint, shallow or tight footwear can rub directly against it and make symptoms considerably worse.

Consider a Stiffer Sole

Very flexible shoes require the big toe to bend as you push forward.

A shoe with a relatively stiff sole can reduce the amount of movement required through the painful joint.

Some people therefore find firmer-soled walking shoes or footwear with a rocker-style sole more comfortable than very flexible footwear.

Rocker Sole Footwear

Rocker-style soles are curved through the forefoot.

Rather than requiring as much bending through the big toe as you move forward, the shoe helps the body roll over the front of the foot.

This can make walking more comfortable for some people with a painful or restricted first MTP joint.

Can Insoles Help Hallux Rigidus?

Insoles and orthoses can sometimes be useful, depending on the individual.

Their purpose isn't to reverse arthritis. Instead, an appropriately selected insole may help redistribute pressure or influence how forces pass through the foot.

For someone with hallux rigidus, the type of insole required will depend on their foot mechanics, symptoms and footwear.

A very soft cushioning insole isn't necessarily the same as an orthotic designed to provide greater structural support.

See our range of Orthotics & Insoles

Carbon Fibre Insoles and Stiff Inserts

A stiff insert or carbon fibre plate is sometimes used for hallux rigidus because it can reduce how much the big toe joint bends inside the shoe.

This can be helpful when bending the joint is painful.

These inserts work differently from soft cushioning insoles. Rather than primarily absorbing impact, their purpose is to limit movement through the forefoot and first MTP joint.

They can make footwear feel considerably firmer, so they're not necessarily appropriate or comfortable for everyone.

Can the OS1st Turf Toe Brace Help?

The OS1st Turf Toe Brace is another option designed to influence movement around the big toe joint.

Although originally designed with turf toe in mind, its design may also be useful for some people looking to limit painful movement around the first MTP joint.

The brace uses a tension-band design underneath the big toe and first metatarsal. This provides support around the joint during the push-off phase of walking.

For someone with hallux rigidus or hallux limitus, reducing uncomfortable movement through the joint may improve comfort during certain activities.

However, hallux rigidus varies considerably between individuals, so a brace won't be suitable or effective for everyone.

Activity and Hallux Rigidus

Having hallux rigidus doesn't necessarily mean you need to stop exercising.

The important consideration is how your big toe responds to the activity.

Activities involving repeated or forceful bending of the big toe may aggravate symptoms. If this happens, temporarily modifying the activity or choosing an alternative can help.

Cycling, swimming and some forms of strength training may place different demands on the big toe compared with running or activities involving repeated push-off.

The goal should generally be to remain active while finding activities and footwear that don't repeatedly aggravate the joint.

Should You Exercise a Stiff Big Toe?

This depends on the cause and severity of the restriction.

It's tempting to assume that a stiff joint simply needs to be stretched more. However, if movement is restricted because of arthritic changes or a bony block within the joint, repeatedly forcing the toe into a painful range isn't necessarily helpful.

Exercises targeting surrounding foot and lower-limb strength and mobility may form part of an individual management program.

If you're unsure which exercises are appropriate, a podiatrist can assess the joint and advise you.

What About Ice and Anti-Inflammatory Treatment?

Some people find a cold pack helpful for temporarily settling discomfort after activities that aggravate the joint.

Always protect the skin rather than applying ice directly.

Medication or other anti-inflammatory treatments may also be considered in some circumstances. These are best discussed with your GP, pharmacist or treating health professional, particularly if you have other medical conditions or take medication.

When Is Surgery Considered?

Most people will initially try conservative strategies such as footwear modification, activity modification, insoles or methods of reducing painful joint movement.

However, when symptoms remain significant despite conservative treatment, a specialist may discuss surgical options.

The appropriate procedure depends on factors including the severity of the arthritis, remaining joint movement, age, activity level and individual goals.

A podiatric or orthopaedic surgeon can discuss the available options if surgery is being considered.

Hallux Rigidus vs Hallux Valgus: What's the Difference?

These two conditions affect the same general area of the foot but are different problems.

Hallux rigidus is arthritis and stiffness of the big toe joint.

Hallux valgus, commonly known as a bunion, involves a change in alignment where the big toe angles towards the smaller toes and the first metatarsal becomes more prominent.

It is possible for someone to have features of both conditions, but one isn't simply another name for the other.

Frequently Asked Questions

Does Hallux Rigidus Get Worse Over Time?

Hallux rigidus is considered a progressive form of arthritis, but the rate at which symptoms and joint changes progress varies considerably between individuals.

Some people experience relatively stable symptoms for long periods, while others develop increasing stiffness and discomfort.

Can Hallux Rigidus Be Managed Without Surgery?

Yes. Many people manage their symptoms using conservative strategies such as appropriate footwear, reducing painful joint movement, activity modification and, where appropriate, insoles, orthoses or braces.

Surgery may be considered when symptoms remain significant despite conservative treatment.

What Shoes Are Best for Hallux Rigidus?

Shoes with adequate width and depth around the big toe are generally preferable.

A relatively stiff sole or rocker-style sole may also reduce the amount the big toe needs to bend during walking.

Very flexible shoes and footwear that places pressure directly over a prominent joint may be less comfortable.

Can I Run With Hallux Rigidus?

Some people with mild hallux rigidus can continue running comfortably, while others find running aggravates their symptoms.

There isn't a single rule that applies to everyone.

Footwear, running volume, the severity of the joint changes and the individual's symptoms all need to be considered.

Should I Stretch My Big Toe if I Have Hallux Rigidus?

Not necessarily.

If the joint is restricted because of arthritic or bony changes, repeatedly forcing it into a painful range may irritate the joint.

If you're unsure whether mobility exercises are appropriate, have the joint assessed before starting an aggressive stretching program.

Living With Hallux Rigidus

Hallux rigidus can make something as simple as walking uncomfortable, but there are a number of ways to manage symptoms.

The key is understanding why the joint is painful and what makes it worse.

For many people, choosing appropriate footwear and reducing excessive or painful bending through the big toe joint can make everyday activities more comfortable. Insoles, stiff inserts or braces may also have a role depending on the individual.

If pain persists, the joint becomes increasingly stiff or your symptoms are changing the way you walk, consider seeing a podiatrist or other qualified health professional for an individual assessment.

At The Footcare Shop, we stock a range of podiatrist-selected insoles, supports and foot care products that may assist with comfort and support for a variety of foot concerns.