Hallux Rigidus Causes, Symptoms & Treatment Options

Overview

Hallux rigidus, commonly known as “stiff big toe,” is a degenerative arthritic condition that affects the MTP joint at the base of the big toe. This joint plays an important role in balance and forward motion while walking. Because of this, arthritis in the big toe joint often leads to pain, loss of motion, and difficulty with daily activities.

In many people, symptoms begin gradually. You may notice mild soreness after long walks or stiffness when bending the toe upward. As the condition progresses, movement becomes more restricted, and the joint can develop bone spurs on top of the toe. These bony bumps may make wearing regular shoes uncomfortable. Activities like running, squatting, or climbing stairs often increase hallux rigidus symptoms, especially as the joint becomes more arthritic over time.

What causes Hallux Rigidus?

The exact cause of hallux rigidus is not always clear, but several factors can contribute to the condition:

1. Overuse and Repetitive Stress: Repeated pressure on the big toe, such as frequent squatting or pushing off during sports, can wear down the cartilage and lead to arthritis. 
2. Previous Injury: A past injury, such as “turf toe,” can damage the cartilage of the MTP joint. Even if symptoms improve at the time, long-term joint wear can later lead to hallux rigidus.
3. How the Condition Develops: As cartilage breaks down, the joint becomes inflamed and stiff. The body sometimes forms bone spurs around the toe in an attempt to stabilize the joint, but this can actually limit motion further and increase pain.
4. Common Everyday Causes: Daily habits like wearing tight shoes, standing for long hours, or walking on hard surfaces can worsen symptoms or increase the risk of developing the condition.

Sports Where Hallux Rigidus Is Common

Hallux rigidus often affects athletes who repeatedly push off the big toe or place stress on the front of the foot, including:

• Basketball: jumping and quick direction changes
• Baseball: especially catchers who squat frequently
• Softball: repetitive forward motion
• Dance: strong toe extension and balance
• Football: forceful push-off movements
  
• Tennis: sudden stops and pivots

Symptoms

The most common symptoms of hallux rigidus include:

Pain and Swelling

You may feel soreness at the base of the big toe, especially during walking or exercise. Swelling around the joint is common during flare-ups.

Joint Stiffness

Limited movement in the big toe, especially upward bending (dorsiflexion), is often the first noticeable sign. This stiffness can make it hard to walk normally.

Bone Spurs or Bumps

A bump may form on top of the big toe joint, which can rub against shoes and create discomfort.

Dorsiflexion Pain

Activities that require bending the toes upward, like running, climbing stairs, or pushing off during walking, may trigger sharp or aching pain.

Non-operative treatment

In mild to moderate cases, non-surgical care can greatly reduce symptoms and slow the progression of hallux rigidus. Treatment options include: 

Supportive Footwear

Switch to shoes with a cushioned, stiff rocker-bottom sole and a roomy toe box. This reduces pressure on the big toe and helps you move more comfortably. Avoid flip-flops, flexible-sole shoes, and high heels.

Orthotics

A semi-rigid or rigid Morton’s extension orthotic can help support the big toe and limit painful motion.

Medications

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen help reduce pain and inflammation.

Steroid Injections

Your orthopedic specialist may inject corticosteroids into the joint to decrease inflammation and provide temporary relief.

Exercises

Special exercises can help maintain the range of motion, loosen tight tissues, and improve overall foot function. Your doctor or physical therapist may provide a structured program.

Try these exercises to help address your condition:

Below is a PDF of the Exercise Program

Hallux Rigidus

Surgical Treatment

If conservative hallux rigidus treatment fails or symptoms become severe, surgery may be recommended. The best procedure depends on how advanced the arthritis is.

Cheilectomy

Used for moderate cases. Bone spurs are removed to reduce pain and improve motion.

Osteotomy

A small wedge of bone may be removed to create more space in the joint, improving flexibility and reducing pressure.

Arthrodesis (Fusion)

For severe arthritis where cartilage is badly damaged. The bones of the joint are fused together. You will no longer be able to bend the toe, but this procedure reliably eliminates pain and restores stability.