Hallux Rigidus (Big Toe Pain)

What is it?

Pain and stiffness in the big toe, sometimes referred to as Hallux Rigidus, is normally caused by  arthritis at the metatarsophalangeal (MTP) joint which is the base of the big toe.  This gradually causes a reduced range of movement and pain around the base of the first toe.

Why does it occur?

General wear and tear and repetitive use are the main causes of most cases of arthritis. In some instances it can run in families. Previous trauma to the joint may also play a part in big toe pain.

What are the symptoms?

Pain and reduced range of movement around the big toe joint are common symptoms, making extending or bending the big toe upwards particularly problematic. This makes walking difficult, as the foot is unable to move through its normal range. Deformity and lumpiness at the bottom of the big toe can also become a problem.

How is it diagnosed?

Your consultant will take a medical history and physical  examination and, with appropriate x-rays showing the extent of any degeneration or arthritis, make the diagnosis.

How is it treated?

The best course of treatment will depend on a number of factors including your general health, activity levels, the severity of the symptoms, as well as the affect the arthritis has had on your foot. 

Non-surgical treatment

Custom-made insoles or shoes with a rocker bottom may be prescribed, as either will mean that the big toe joint has to move less while you are walking, which will often improve your symptoms.  Regular analgesia can also help.

Surgical treatment

Depending on the severity and pattern of any arthritis, there are a number of different surgical options. In the early stages, surgery to remove bony spurs around the joint can improve the range of movement and reduce the pain when extending the toe.  If the arthritis is more established, the toe joint may need to be fused or replaced in order to eliminate the pain.

Treatment options

Cheilectomy

GASTROCNEMIUS RELEASE 4

Gastronemius release

Foot surgery

Forefoot reconstruction

The One Orthopaedics team specialists

Julie Kohls

Consultant Orthopaedic Foot and Ankle Surgeon FRCS (Tr & Orth)