What Is Hallux Rigidus?

Overview

Hallux rigidus is a common arthritis condition that affects the joint at the base of the big toe and is often referred to as big toe arthritis.¹

The big toe has two joints, with the larger joint being the metatarsophalangeal (MTP) joint. This is the joint closest to the base of the big toe, where the first long bone of the foot meets the first bone of the toe. The main function of the MTP joint is to bend and grip the ground, as well as to support foot flexibility when walking.¹

Hallux rigidus can make walking painful and difficult, so you may need surgery if it is affecting your ability to perform your daily activities. However, there are also many non-surgical treatment options available that are effective at relieving pain and discomfort.

This article will explain the stages of hallux rigidus, as well as the causes, symptoms, diagnosis, and possible treatment options.

Hallux rigidus stages

Hallux rigidus is classified into different stages, which are based on how much the condition affects your ability to move your big toe:¹

• Grade 0: 10% to 20% loss of movement with no pain, only stiffness
• Grade 1: 20% to 50% loss of movement compared to the normal side, with mild pain and stiffness
• Grade 2: 50% to 75% less movement with moderate to severe pain and stiffness that may be constant
• Grade 3: 75% to 100% less movement with constant pain and extreme stiffness
• Grade 4: 75% to 100% less movement with severe pain and stiffness when moving your big toe

Causes of hallux rigidus

The ends of the bones in the big toe are covered by a smooth articular cartilage, and if this cartilage is damaged, the ends of the bones can rub together. This can cause the development of a bone spur (osteophyte), or an overgrowth on the top of the toe on the base of the big toe. This can prevent the big toe from bending, which can affect your ability to walk.

As the condition progresses, all the cartilage is worn away which leaves bone-on-bone arthritis within the MTP joint.

In most cases, hallux rigidus develops naturally over time without a clear cause. As we age, normal wear and tear on your joints can damage the cartilage in your big toe and cause hallux rigidus. As well as this, the MTP joint in the big toe experiences a lot of stress when you walk as it bears your body weight with every step you take.¹

Other causes of hallux rigidus include:

• A past traumatic injury to the big toe
• Overusing the MTP joint (e.g. due to sport, job, or hobby)
• Poor foot alignment (e.g. flat feet or bunion)
• Stubbing your toe
• Turf toe
• Having bones that are longer than usual in your feet and toes
• Genetic factors

Signs and symptoms of hallux rigidus

The symptoms of hallux rigidus may vary, but common symptoms include:

• Pain in, or around, the big toe when walking or doing other activities
• Stiffness in the big toe
• Swelling of the big toe
• A bump, like a bunion or a callus, on top of your big toe

Conditions or activities that may worsen your symptoms include:

• Standing or moving
• Tight shoes
• Cold, damp conditions

Diagnosis

If you think you have symptoms of hallux rigidus then it is important to see a doctor – as the earlier the diagnosis, the easier it is to treat the condition.

A physical examination is needed to diagnose Hallux rigidus. The doctor will examine your foot, test the range of motion of your big toe and see how far it can bend up and down. This will help determine how deep the pain is and what treatment is needed.

Your doctor may also use an X-ray to examine your foot. This is useful in identifying the location and size of any bone spurs, cartilage loss, and the stage of arthritis in the joint space.²

Management and treatment for hallux rigidus

Treatment for hallux rigidus depends on the cause and severity of the condition. Treatment often begins with non-operative options that aim to relieve pain. One study found a 55% success rate with non-surgical treatment, which included corticosteroid injections and shoe modifications.²

Non surgical treatment

Pain relievers

Your doctor may recommend pain relievers such as non-steroidal anti-inflammatory drugs (NSAIDs) that can relieve pain and reduce swelling.²

Shoe changes

To relieve pressure on your MTP joint, you should wear shoes that have plenty of room for your toes. High heels and shoes with a small toe box should be avoided. As well as this, shoes with stiff soles may relieve pain. This includes shoes with a rocker or roller bottom design or a standard shoe fitted with a stiff carbon fibre insert (Morton’s extension) or metal plate.²

Icing

You can also apply ice or cold packs to the toe to temporarily help reduce inflammation and ease your symptoms. You should wrap the ice or cold pack in a thin towel to avoid applying it directly to the skin.

Limiting toe movement

Your doctor may suggest a pad you can put in your shoe that can help limit the movement of your big toe. You should also avoid activities that put pressure on your toe joint such as running or playing sports.

Contrast bath

Your doctor may suggest soaking your foot in a contrast bath, which uses alternating cold and hot water to reduce inflammation. This can be done up to three times a day, but extreme temperatures in the water should be avoided.

Injections 

Injections of corticosteroids or hyaluronic acid into the MTP joint can reduce inflammation and provide temporary relief.²

Surgical treatment

Although most people find relief from non-surgical treatments, your doctor may recommend surgery if other options are not effective or your symptoms are severe.

Cheilectomy

A cheilectomy involves shaving down any bone spurs or growths on your MTP joint in order to give your toe more room to bend. This is usually recommended for patients with a mild or moderate form of the condition. Research shows decreased success in patients who have more advanced hallux rigidus.²

Osteotomy

This involves cutting the bones in your toe to realign or shorten your big toe.

Arthroplasty

Arthroplasty is a joint replacement surgery in which an orthopaedic surgeon removes the damaged bone in your MTP joint and implants an artificial joint. This is effective at relieving pain and preserving joint motion.

Arthrodesis

This process involves fusing the bones together. An orthopaedic surgeon will remove the damaged cartilage and fix the joint in a permanent position through the use of pins, screws, or a plate. As the bones grow, they will fuse together and eliminate the toe joint, which restricts how much you can move and bend your big toe. This is often recommended for patients with severe hallux rigidus or if a cheilectomy was unsuccessful.²

Risk factors

Anyone can get hallux rigidus, but it is more common in people who are:

• Over the age of 50
• Assigned female at birth (AFAB)
• Working on their feet all day
• Athletes

As well as this, certain health conditions can increase your risk for hallux rigidus. This includes:

• Rheumatoid arthritis
• Autoimmune diseases
• Gout
• Osteochondritis dissecans

FAQs

How can I prevent hallux rigidus?

You cannot prevent hallux rigidus, but you can slow down the progression of the condition by:

• Wearing shoes that are well-fitted and have enough space around your toes
• Resting your foot after intense physical activity
• Keeping your big toe joint mobile by frequently exercising

How common is hallux rigidus?

Hallux rigidus is the most common type of foot arthritis and is the second most common condition affecting the MTP joint after bunions (hallux valgus). Research suggests that 1 in 40 adults over the age of 50 have hallux rigidus.¹

When should I see a doctor?

You should see a doctor as soon as you notice pain in or around your big toe joint. The earlier the diagnosis, the easier it is to treat the condition.¹

Summary

In summary, hallux rigidus is a type of arthritis that causes pain and stiffness in the big toe joint known as the metatarsophalangeal (MTP) joint. In most cases, it develops naturally over time due to normal wear and tear on your joints – but it can also be caused by overusing the MTP joint, a past traumatic injury to the big toe, poor foot alignment, and genetic factors. To diagnose the condition, a doctor will examine your foot and test the range of motion of your big toe. They may also use a foot X-ray for further examination. Most people manage their symptoms using non-surgical treatments, such as pain relievers, shoe modifications, icing, and injections of corticosteroids. However, in severe cases, surgery may be needed. Surgical treatment options include cheilectomy, osteotomy, arthroplasty, and arthrodesis.