Hallux Rigidus

What is hallux rigidus?

Hallux rigidus is a type of arthritis in your big toe. Specifically, it affects your big toe joint — the metatarsophalangeal (MTP) joint. Your MTP joint is where the base of your big toe meets your foot.

“Arthritis” is a general term for a group of more than 100 diseases. It causes inflammation (swelling) in and around your joints. Healthcare providers sometimes call hallux rigidus “big toe arthritis.”

Hallux rigidus means “stiff big toe” — the condition’s most common symptom. It causes pain and stiffness in your MTP joint. It’s a form of osteoarthritis (“wear and tear arthritis”).

Visit a healthcare provider if you’re experiencing symptoms like pain, stiffness or swelling in your big toe or foot.

How common is hallux rigidus?

Experts estimate that around 1 in 40 adults older than 50 have hallux rigidus. It’s the most common type of foot arthritis.

Hallux rigidus is the second most common MTP joint condition after bunions (hallux valgus).

What are hallux rigidus symptoms?

The most common hallux rigidus symptoms include:

• Pain in or around your big toe. It usually feels like the pain is on the top of your toe, but you may feel it deeper or inside your toe, too.
• Stiffness in your big toe.
• Swelling around your big toe joint.
• Losing range of motion in your big toe (how far you can comfortably move it).
• A bump that looks like a bunion or callus on top of your big toe.

Some activities or conditions might make your symptoms worse, including:

• Standing or moving.
• Cold, damp weather.
• Wearing shoes that are too tight or don’t properly fit your feet.

What causes hallux rigidus?

Most cases of hallux rigidus develop naturally over time without an obvious cause. As you age, normal wear and tear on your joints can add up to damage the cartilage that cushions them. This wear and tear is usually what causes hallux rigidus (and other forms of osteoarthritis).

Hallux rigidus likely develops because your big toe joint experiences a lot of stress when you walk. Every step you take places a force equal to twice your body weight on the MTP joint.

Other causes of hallux rigidus include:

• Overusing the MTP joint (like during a sport, hobby or job).
• Stubbing your toe.
• Turf toe (a toe sprain).
• Having longer-than-usual bones in your feet and toes.

Hallux rigidus risk factors

Anyone can develop hallux rigidus, but it’s more common in certain groups of people, including:

• People older than 50.
• Women and people assigned female at birth (AFAB).
• Athletes.
• People who are on their feet all day at work.

Certain health conditions can make you more likely to develop hallux rigidus, including:

• Rheumatoid arthritis.
• Gout.
• Autoimmune disorders that cause inflammation.
• Osteochondritis dissecans.

How is hallux rigidus diagnosed?

A healthcare provider will diagnose hallux rigidus with a physical exam. They’ll test your toe joint’s range of motion and check how far you can bend your toe up and down. You might need to visit a podiatrist — a healthcare provider who specializes in taking care of your feet.

Your provider might use a foot X-ray to take pictures of your foot and check for bone spurs.

Hallux rigidus stages

Your provider might classify hallux rigidus with a grade based on how much it affects your ability to move your big toe. They might call these grades stages if your symptoms are getting more severe over time. Hallux rigidus grades include:

• Grade 0: Your affected toe can move 10% – 20 % less than your other big toe.
• Grade 1: 20% – 50% less movement in your affected big toe.
• Grade 2: 50% – 75% less movement.
• Grade 3: 75% – 100% less movement.
• Grade 4: 75% – 100% less movement along with more severe pain while moving your affected big toe.

What is the best treatment for hallux rigidus?

Which treatment you’ll need depends on the severity of your symptoms and what caused hallux rigidus. Your provider might suggest:

• Footwear changes: Wearing shoes that have plenty of room for your toes can relieve pressure on your MTP joint. Shoes with stiff soles relieve pain. Avoid wearing high heels or shoes that squeeze your toes (have a small toe box).
• Limiting your toe movement: Your provider may recommend over-the-counter (OTC) pads that you can put in your shoe to support your big toe and limit its movement. You might need to avoid activities that stress your toe joint, like running or playing sports.
• Pain relievers: Over-the-counter nonsteroidal anti-inflammatory medications (NSAIDs) can relieve pain and reduce swelling. Don’t take NSAIDs for more than 10 days in a row without talking to your provider.
• Icing: Applying ice or cold packs to your affected toe can relieve your symptoms. Wrap a cold pack in a thin towel to avoid putting it directly onto your skin. Ask your provider how often (and for how long) you should ice your toe.
• Corticosteroids: Corticosteroids are prescription medications that reduce inflammation. You may need cortisone shots injected directly into your big toe joint.
• Foot soaks: Your provider might suggest soaking your feet in a contrast bath, switching between hot and cold water to relieve inflammation. Place your foot in hot water for 30 seconds, then right away in cold water for 30 seconds.

Will I need surgery for hallux rigidus?

Most people don’t need surgery to treat hallux rigidus. Your provider might suggest surgery if other treatments don’t relieve your symptoms, or if the hallux rigidus makes it hard (or impossible) to participate in your daily routine.

Surgical procedures for hallux rigidus include:

• Cheilectomy (kie-LEK-toe-me): A cheilectomy gives your toe more room to bend. Your surgeon will shave down any bone spurs or growths on your MTP joint to relieve pain and help your joint move better.
• Osteotomy: Your surgeon will cut your toe bones to realign or shorten your affected big toe.
• Arthroplasty: An arthroplasty is a joint replacement. Your surgeon will remove the damaged bone in your MTP joint and replace it with a “spacer” of donor tissue between the joint ends.
• Arthrodesis: An arthrodesis is a joint fusion. Your surgeon will remove damaged cartilage and join the bones in your joint together. This surgery offers a permanent solution but may restrict how much you can move your big toe.

Hallux rigidus surgery complications

Complications from hallux rigidus surgery are rare, but they can happen. The most common complications include:

• Infection.
• Joint stiffness.
• Arthritis progression (getting worse).
• Misshapen toe recurring (coming back).
• Long-term swelling.

How long does it take to recover from hallux rigidus?

How long it takes to recover depends on which treatments you need and how severe the hallux rigidus is. Treatments like switching shoes and wearing toe pads might be all you need to relieve your symptoms. If that’s the case, you should be able to return to your usual routine as soon as your provider says it’s safe.

If you need hallux rigidus surgery, your recovery time will depend on which procedure your surgeon performed:

• Cheilectomy and arthroplasty: You’ll wear a special shoe for about two weeks before returning to regular footwear. Swelling may last for a few months.
• Osteotomy: Swelling should go down in six to eight weeks. Complete healing can take up to three months.
• Joint fusion: You’ll wear a cast or boot for three to six weeks. Then you’ll need crutches for a few weeks. You may have some swelling and stiffness for a few months after the procedure.

Can I prevent hallux rigidus?

You probably can’t prevent hallux rigidus from developing, but you may be able to slow down its progression if you:

• Exercise to keep your big toe joint mobile.
• Rest your joint after intense physical activity — never play through pain.
• Wear well-fitting shoes with enough space around your toes.

What’s the outlook for hallux rigidus?

With the right treatment, you can reduce pain and inflammation so you can get back to your usual activities. Some hallux rigidus surgeries may leave you with a limited ability to bend your toe, but you can still be active. Your provider or surgeon will tell you what to expect, and which activities to avoid.

Can you get rid of hallux rigidus?

Surgery is usually the only way to permanently get rid of hallux rigidus. But most people with hallux rigidus are able to find a combination of nonsurgical treatments that manage their symptoms.

When should I visit a healthcare provider if I have big toe joint pain?

Visit a healthcare provider or podiatrist as soon as you notice new pain in or around your big toe joint. They’ll diagnose what’s causing the pain and any other symptoms you’re experiencing and will suggest treatments to relieve them.

What questions should I ask my provider?

• Which treatments will I need?
• What type of shoes should I wear?
• Is it OK to keep exercising or playing sports?
• Can medication help?
• Will I need surgery?
• How can I prevent hallux rigidus from getting worse?

If I have hallux rigidus, am I at higher risk for developing other types of arthritis?

Not necessarily. You might be more likely to develop hallux rigidus in your other foot. But having hallux rigidus doesn’t increase your odds of having arthritis in other joints throughout your body.

A note from Cleveland Clinic

If you have big toe joint pain, talk to your healthcare provider. The earlier they diagnose hallux rigidus, the more successful treatment can be. Most people only need nonsurgical treatments to manage their symptoms. But if lingering pain interferes with your life, surgery can help. There are several hallux rigidus surgery options. Your provider and surgeon will discuss your options with you and help you decide which treatment is right for you.