Your big toe does a lot of work. It bends every time you push off to take a step, climb stairs or crouch down. So when the joint at the base of that toe gets stiff and sore, you notice it, on a walk, at work or in the garden.

One common reason is arthritis in the big toe joint, called hallux rigidus. Here's what it is, what it tends to feel like, what may help, and when to have it looked at.

What Is Hallux Rigidus?

Hallux rigidus is arthritis in the joint at the base of the big toe.1,3 That joint is called the metatarsophalangeal (MTP) joint. It's where the big toe meets the rest of the foot.1,3 The name is Latin for "stiff toe."4 The American Academy of Orthopaedic Surgeons (AAOS) calls it the most common arthritic condition in the foot.1

The condition gets worse over time, and the toe slowly loses its ability to move.2 In the earlier stage, when the toe can still bend some, it's often called hallux limitus. "Hallux rigidus" usually means a joint with almost no motion left.2,4

Who Gets Big Toe Arthritis?

It usually shows up in adults between 30 and 60.1 Cleveland Clinic says experts estimate about 1 in 40 adults older than 50 have it.3 Women are about twice as likely as men to develop it.4

Cleveland Clinic lists these risk factors: being older than 50, being female, being an athlete, and being on your feet all day at work.3 That last one covers a lot of Montana jobs, from ranch work to nursing to retail.

What Causes It?

Most of the time, hallux rigidus comes from wear and tear on the joint over time.1,3 The cartilage that cushions the ends of the bones gets damaged.1 The joint takes a lot of force. Cleveland Clinic notes that every step puts a force equal to about twice your body weight on it.3

Other things that can play a part include:

  • Past injuries. An earlier injury to the big toe, including turf toe, can damage the joint.1,2,3
  • Foot shape and alignment. Flat feet, a bunion, or the way your foot moves as you walk.1,2 A longer-than-usual foot bone can also play a part.3
  • Family history. It can run in families.1,2
  • Repeated stooping or squatting in your job or activities.2
  • Inflammatory conditions. Rheumatoid arthritis and gout are both linked to it.2,3,4 Our article on gout in the foot and big toe explains more about gout.

One thing that isn't on the list: StatPearls notes that shoes don't cause hallux rigidus.4 The wrong shoes can make it hurt more, though.3

What Does It Feel Like?

Early on, you may notice:1,2,3

  • Pain and stiffness in the big toe joint when you walk, stand or are active
  • Trouble bending the big toe up or down
  • Swelling around the joint
  • Pain that's worse in cold, damp weather
  • Trouble running or squatting

As it goes on, the signs can change:1,2

  • A bump on the top of the foot, a bit like a bunion or callus. This is often a bone spur.
  • Pain even when you're resting
  • Shoes that are hard to wear because of the bump and swelling
  • Dull pain in the hip, knee or lower back, because you start walking differently to protect the toe

Is It a Bunion or Hallux Rigidus?

Both affect the same joint, and both can cause a bump.1,3 The difference is in where the bump sits and how the toe moves. With hallux rigidus, the bump is usually on the top of the foot and the main problem is stiffness.1 Our article on bunions and our bunion care page explain how bunions differ. A podiatrist can tell the two apart.

How Is It Diagnosed?

A provider will look at your foot and check how far the big toe bends and where it hurts.1,3 X-rays show how much arthritis is in the joint and whether bone spurs have formed.1,2,3 StatPearls notes that X-rays taken while you stand are the usual test, and MRI or CT scans aren't needed to diagnose it.4

What Can Help Without Surgery?

Many people manage their symptoms without surgery.3,4 Options described by AAOS, the American College of Foot and Ankle Surgeons (ACFAS) and Cleveland Clinic include:1,2,3

  • Roomier shoes. Shoes with plenty of room for your toes can ease pressure on the joint. Cleveland Clinic suggests avoiding high heels and shoes that squeeze your toes.3
  • Stiff-soled shoes. A stiff sole, sometimes with a curved "rocker" bottom, means the toe doesn't have to bend as much when you walk.1,3,4
  • Inserts and orthotics. A stiff insert called a Morton's extension or custom orthotics may help limit painful motion.1,2,4
  • Ice to calm inflammation.1,3 Cleveland Clinic also describes contrast baths: 30 seconds in hot water, then 30 seconds in cold water.3
  • Anti-inflammatory pain relievers (NSAIDs). Cleveland Clinic advises not taking them for more than 10 days in a row without talking to your provider.3
  • Steroid injections into the joint, given by a provider.1,2,3
  • Physical therapy.2

For everyday shoe-shopping tips, see our article on proper footwear.

When Is Surgery an Option?

Surgery may be considered when other treatments haven't helped.2 The type depends on how severe the arthritis is, your age and how active you are.2 Procedures described by AAOS and Cleveland Clinic include removing bone spurs (cheilectomy), fusing the joint (arthrodesis) and different types of joint replacement.1,3 Recovery varies by procedure, from a couple of weeks in special shoes to several weeks in a cast.1,3 A foot and ankle specialist can explain what would fit your situation.

Can I Slow It Down?

Cleveland Clinic notes that you may not be able to prevent hallux rigidus, but some habits may help slow it down:3

  • Exercise to keep the big toe joint moving
  • Rest the joint after hard activity, and don't play through pain
  • Wear shoes that fit well

When Should I See a Podiatrist?

Cleveland Clinic advises seeing a provider as soon as you notice new pain in or around the big toe joint.3 ACFAS agrees that it's best to get checked when symptoms first show up. If you wait until bone spurs form, the condition is likely to be harder to manage.2

If your big toe suddenly becomes very painful, red, hot or swollen, or you can't put weight on your foot, don't wait on the web form. Call us: Butte & Anaconda (406) 782-2278, Bozeman, Ennis & Harlowton (406) 587-8478. For a severe injury, go to an emergency room.

The Bottom Line

Hallux rigidus is arthritis in the joint at the base of the big toe. It usually causes pain and stiffness that get worse with activity, and it can lead to a bump on top of the foot. It tends to worsen over time. Roomy, stiff-soled shoes, inserts, ice and other treatments help many people manage it, and getting checked early gives you more options.

If your big toe is slowing you down, our podiatrists can help. Request an appointment and our team will follow up within one business day. You can also find your nearest office on our locations page.

This article is for general education and isn't a substitute for medical advice. Talk with a podiatrist or your doctor about your own symptoms.

Sources

  1. Hallux Rigidus (Stiff Big Toe). OrthoInfo, American Academy of Orthopaedic Surgeons (AAOS). www.orthoinfo.org
  2. Hallux Rigidus. FootHealthFacts.org, American College of Foot and Ankle Surgeons (ACFAS). www.foothealthfacts.org
  3. Hallux Rigidus: Symptoms, Causes & Treatment. Cleveland Clinic. my.clevelandclinic.org
  4. Patel J, Swords M. Hallux Rigidus. StatPearls, NCBI Bookshelf, National Library of Medicine. www.ncbi.nlm.nih.gov