What is hallux rigidus?
Hallux rigidus means “stiff big toe” — the main symptom of the disorder. Hallux rigidus is a type of degenerative arthritis, a common type of arthritis. It’s sometimes called “big toe arthritis.”
How does hallux rigidus affect me?
Hallux rigidus causes pain and stiffness in the metatarsophalangeal (MTP) joint. That’s the joint where your big toe (the hallux) meets your foot.
Hallux rigidus is a progressive condition, which means it can get worse over time. Some people find that it never gets much worse than when it started. But for others, the pain and stiffness worsen. They have less and less motion in the joint.
Is hallux rigidus the same as hallux valgus?
These conditions are both big toe disorders. Hallux valgus (bunions) is the most common big toe disorder. Hallux rigidus is the second most common.
Who does hallux rigidus affect?
Hallux rigidus occurs in teens and adults. It’s most common in people between the ages of 30 and 60.
How common is hallux rigidus?
This condition occurs in approximately 1 in 40 patients over the age of 50.
Symptoms and Causes
What causes hallux rigidus?
For most people, there is no clear cause. Hallux rigidus likely develops because the 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 toe joint.
Other causes of hallux rigidus include:
- Overuse of the joint, such as in workers who stoop or squat or athletes who stress the joint.
- Injuries, such as stubbing the toe or spraining the joint (called “turf toe” in athletes).
- Genetics, since it can run in the family. It may come from inheriting a particular foot type (like a long first foot bone) or way of walking that leads to the condition.
- Osteoarthritis, which is joint inflammation due to wear and tear on the joint.
- Inflammatory diseases, such as rheumatoid arthritis or gout.
What are the symptoms of hallux rigidus?
The main symptom is pain in your big toe, especially when you push off as you walk. If the condition gets worse, you may notice:
- Your toe’s motion decreases over time so that walking or even standing is painful.
- Pain and stiffness worsen in cold, damp weather.
- Your toe joint becomes swollen and inflamed.
- A bump, like a bunion or callus, develops on the top of the foot. Wearing shoes might be uncomfortable.
Diagnosis and Tests
How is hallux rigidus diagnosed?
Your healthcare provider can diagnose hallux rigidus by testing your toe joint’s range of motion. Your provider may check how far you can bend the toe up and down. An X-ray can show any bone abnormalities or bone spur development.
Management and Treatment
How is hallux rigidus treated?
To relieve pain, your healthcare provider may recommend:
- Appropriate shoes: Wear shoes that have plenty of room for your toes. You may find that shoes with stiff soles relieve pain. Avoid wearing high heels.
- Limited toe movement: Place pads in your shoe to limit movement of your big toe. Avoid activities that stress your toe joint, such as jogging.
- Pain relievers: Nonsteroidal anti-inflammatory medications, such as ibuprofen, can relieve pain and reduce swelling.
- Foot soaks: Try 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.
- Injections: Corticosteroid injections can help relieve pain.
Will I need surgery for hallux rigidus?
Sometimes, conservative measures aren’t enough. You may still have pain and stiffness. If the pain interferes with your life, surgery can help. Surgical procedures for hallux rigidus include:
- Cheilectomy (kie-LEK-toe-me): Shaving the bone spur can help relieve pain and preserve joint motion. A cheilectomy allows more room for the toe to bend.
- Osteotomy: Cutting the bone can realign or shorten the big toe.
- Interpositional arthroplasty: Healthcare providers may recommend this joint resurfacing procedure for younger patients. Surgeons remove some of the damaged bone. They place a “spacer” of donor tissue between the joint ends to relieve pain.
- Arthrodesis: For severe cases, this joint fusion procedure can provide long-lasting pain relief. Surgeons remove the damaged cartilage and join the two bones together. This surgery offers a permanent solution but may restrict big toe movement.
Are there complications with hallux rigidus surgery?
While complications are possible after any surgery, they rarely happen after hallux rigidus surgery. Complications can include:
- Joint stiffness.
- Arthritis progression.
- Deformity coming back (recurring).
- Persistent swelling.
What should I expect during recovery from hallux rigidus surgery?
Your recovery depends on the procedure:
- Cheilectomy and interpositional arthroplasty: You wear a special shoe for about two weeks before returning to regular footwear. Swelling may last for a few months.
- Osteotomy: Swelling goes down in six to eight weeks. Complete healing can take up to three months.
- Joint fusion: You wear a cast or boot for three to six weeks. Then you need crutches for two to six weeks. You may have some swelling and stiffness for a few months after the procedure.
When can I return to work after hallux rigidus surgery?
You can most likely return to work about four to eight weeks after surgery. The exact timing depends on your job, activity level and response to surgery.
Can I prevent hallux rigidus?
You can’t keep the condition from happening, but you can slow its progress if you:
- Exercise to keep the joint mobile.
- Rest the joint when you feel pain.
- Wear good-fitting shoes with enough space around the toes.
If I have hallux rigidus, am I at higher risk for developing other types of arthritis?
You may be at higher risk for developing hallux rigidus on your other foot. But you aren’t more likely to get arthritis in other joints, like your hips or knees.
Outlook / Prognosis
What’s the outlook for people with hallux rigidus?
With the right treatment, you can reduce pain and inflammation so you can get back to living an active life. Some hallux rigidus surgeries may leave you with a limited ability to bend your toe, but you can still be active.
Will hallux rigidus go away?
Surgery can offer a permanent solution to the pain and stiffness of hallux rigidus. Nonsurgical treatments can relieve symptoms, but the pain might come back or get worse.
How should I take care of myself if I have big toe joint pain?
Make sure to see your provider if you feel big toe pain so you can get the care you need. Wear shoes with plenty of room in the toes to keep your toes comfortable.
When should I see my healthcare provider?
If you develop symptoms of hallux rigidus, see your provider. Besides pain, signs include walking on the outside of your foot or difficulty bending your toe. Treatment is more successful when a healthcare provider diagnoses the problem early.
What else should I ask my healthcare provider?
If you have hallux rigidus, ask your provider:
- What treatments can help?
- 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 the condition from getting worse?
A note from Cleveland Clinic
If you have big toe joint pain, talk to your healthcare provider. The earlier you get a diagnosis of hallux rigidus, the more successful treatment can be. Often, treatment includes pain medication, getting shoes that fit correctly and resting the joint. But if lingering pain interferes with your life, surgery can help. There are several hallux rigidus surgery options. Your provider will discuss your options with you and help figure out which treatment is right for you.