What is Hallux Rigidus?

Hallux rigidus is a form of degenerative arthritis that affects the metatarsophalangeal (MTP) joint—the large joint at the base of the big toe. The condition’s name literally means “stiff big toe.” Over time, the cartilage that cushions this joint wears down, leading to pain, stiffness, and reduced motion. Because the big toe plays a crucial role in walking, running, and balance, hallux rigidus can significantly impact daily activities.

Causes

Hallux rigidus typically develops from wear and tear arthritis (osteoarthritis), but other factors can contribute:

  • Repetitive stress or overuse of the big toe joint (sports, jobs requiring standing/walking)

  • Previous injury such as turf toe, stubbing, or fractures

  • Foot structure – long first metatarsal, flat feet, or abnormal mechanics

  • Inflammatory conditions – rheumatoid arthritis, gout, autoimmune disorders

  • Genetics – family history of foot arthritis or structural predispositions

Symptoms

Common symptoms include:

  • Pain in or around the big toe joint, especially on the top of the toe

  • Stiffness and reduced range of motion (difficulty bending the toe upward)

  • Swelling and inflammation around the joint

  • A bony bump (bone spur) on top of the joint that may resemble a bunion

  • Pain that worsens with walking, running, or cold/damp weather

  • Difficulty wearing certain shoes due to pressure on the joint

Diagnosis

Diagnosis involves:

  • Physical exam – checking range of motion, tenderness, and swelling

  • X‑rays – to assess joint space narrowing, bone spurs, and arthritis severity

  • Staging/Grading – providers may classify hallux rigidus from mild (Grade 0–1) to severe (Grade 3–4), based on motion loss and arthritis progression

Nonsurgical Treatment

Early and moderate cases are often managed without surgery:

  • Footwear changes – wide toe boxes, stiff soles, rocker‑bottom shoes

  • Orthotics – Morton’s extension inserts or carbon fiber plates to limit painful motion

  • NSAIDs – oral or topical anti‑inflammatory medications

  • Ice or contrast baths – to reduce swelling and pain

  • Activity modification – avoiding high‑impact sports or deep toe bending

  • Corticosteroid injections – for temporary relief of inflammation

When is Surgery Needed?

Surgery may be recommended if pain persists despite conservative care or if the joint becomes severely stiff. Options include:

  • Cheilectomy – removing bone spurs and part of the metatarsal head to improve motion (best for mild to moderate cases)

  • Osteotomy – cutting and realigning the bone to relieve pressure

  • Arthrodesis (fusion) – permanently joining the bones of the joint; highly reliable for pain relief in advanced arthritis but eliminates motion

  • Arthroplasty (joint replacement) – replacing the damaged joint with an implant or tissue spacer; preserves some motion, often used in select patients