What is Hallux Rigidus (Stiff Big Toe/Toe Arthritis)? Symptoms and Treatment

Hallux rigidus, or stiff big toe/big toe arthritis, is one of the most common problems affecting the first metatarsophalangeal joint connecting the big toe to the foot.

What is Hallux Rigidus?

Hallux rigidus is a disorder of the joint at the base of the big toe. It causes pain and stiffness in the joint, progressively making it harder to bend the toe. “Hallux” refers to the big toe, while “rigidus” indicates stiffness and inability to move. Hallux rigidus is essentially a type of degenerative arthritis.

What are the Symptoms of Hallux Rigidus?

Early symptoms include pain and stiffness in the big toe during use, worsening in cold and damp weather; difficulty running or squatting; and swelling and inflammation around the joint.
As the condition worsens, additional symptoms such as pain even during rest, difficulty wearing shoes due to bone spurs, changes in walking posture causing hip, knee, or lower back pain, and in severe cases, limping, may develop.

How is Hallux Rigidus Diagnosed?

The earlier hallux rigidus is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle surgeon is as soon as symptoms appear. Waiting until bone spurs develop can make management more challenging.

As hallux rigidus progresses, the movement of the big toe gradually decreases over time. In the early stages, when movement is only slightly limited, the condition is called “hallux limitus.” As the problem advances, the range of motion reduces further until the toe becomes stiff or “frozen,” referred to as “rigidus.”
Since we use the big toe for walking, bending, climbing, and even standing, this condition can be very uncomfortable and even disabling. Many patients confuse hallux rigidus with bunions affecting the same joint, but these are distinct conditions requiring different treatments.

How is Hallux Rigidus Treated?

The only way to eliminate or reduce pain in hallux rigidus is surgery. Various types of surgeries exist for treating hallux rigidus. The specific deformity’s severity is considered when creating a treatment plan, based on factors like X-ray findings, age, activity level, and other considerations. Recovery time varies depending on the chosen treatment plan.
If pain and stiffness persist, surgery may be necessary. Shaving off the bone spurs (cheilectomy) can help relieve pain and preserve joint movement. Sometimes, the bone may need to be cut (osteotomy) to realign or shorten the big toe.
Interpositional arthroplasty has been successful in younger patients with hallux rigidus. In this procedure, a “spacer” made of donor tissue is placed between joint ends to reduce pain. For severe cases, joint replacement (arthroplasty) or joint fusion (arthrodesis) may be the best long-term solutions for pain relief.