“Hallux rigidus” means “stiff big toe.” This term refers to a type of osteoarthritis that develops when the cartilage in the main joint of your toe has been damaged or worn down, causing discomfort and stiffness.
Osteoarthritis (OA) is the most common type of arthritis. It can affect joints anywhere in your body.
When cartilage in any of your joints wears down, bones become exposed and rub against each other. This causes swelling and pain in the joint and can limit your range of motion.
The base of your big toe, known as the first metatarsophalangeal joint, is a common site for OA.
This article takes a look at the symptoms, causes, and treatment for OA of the big toe.
Even in the early stages, arthritis in your toe can cause tenderness, achiness, and joint pain. You may also feel achiness or pain in other toes or the arch of your foot as you walk.
Over time, you may even develop a burning sensation, which is a common symptom of nerve pain (neuropathy).
A toe that’s affected by arthritis may ache after long periods of sitting or when you first wake up in the morning. Stiffness and pain after long periods of inactivity or immobility are typical symptoms of OA.
| Early symptoms | Later symptoms |
|---|---|
| tenderness and swelling | a burning feeling (neuropathy) |
| achiness | an inability to bend your toe joint |
| joint pain | bone spurs or bunions |
| stiffness | corns or calluses |
| pain in other toes or the arch of your foot | difficulty walking |
Bone spurs and joint fusion
When you have OA in a certain joint, the joint degenerates and your body tries to repair it by growing more bone. This creates bony protrusions called bone spurs. These overgrowths of the big toe bone can make it difficult or even impossible to bend your toe.
The excess bone growth can also lead to fusion of the joint and a fixed (non-bending) joint. The result is a stiff toe (hallux rigidus).
Changing appearance
You may not know you have bone spurs until you develop a visible bump or callus on your toe.
As your big toe changes, it can start to push against your other toes, causing the joint at the base of your big toe to become enlarged. This is known as a bunion. Since this joint capsule enlargement isn’t bone, it won’t show up on X-rays.
Difficulty walking
Walking can be a problem if you can’t bend your big toe.
If you don’t already have bunions, the imbalance in the way you walk can make them more likely to develop. As you walk, bunions push against your shoes, causing your big toe to push against your other toes. As a result, walking becomes painful.
The subsequent rubbing of the outside joint against your shoes can also make walking painful.
Over time, bunions can lead to corns (a central core of hard tissue with callus around it) and calluses.
Your risk for OA increases as you age, mostly as a result of wear and tear. Your body may become less able to heal damaged cartilage as you grow older.
You’re more likely to develop OA if you have:
- a family history of OA
- obesity
- a prior injury to a joint
Hallux rigidus may also result from a toe injury or deformity of your foot. Stiffness in your big toe generally begins between the ages of 30 and 60 years. Onset of OA at an earlier age usually indicates that the condition is due to genetics.
OA of the toe can’t be cured, but you do have some options for managing the pain and swelling:
- Over-the-counter (OTC) medications: OTC pain relievers and nonsteroidal anti-inflammatory drugs (NSAIDs) can help lessen pain and swelling.
- Ice packs: Placing ice packs on your toe can reduce swelling and offer temporary relief.
- Footwear: Choosing the right footwear can make a big difference. High heels, tight shoes, and pointy-toed shoes can encourage the formation of bunions. Choose shoes that allow plenty of room for your big toe.
- Padded inserts and arch supports: You may benefit from padded inserts or arch supports to prevent rubbing and improve comfort.
- Compression socks: Compression socks may also help manage this condition.
- Foot exercises: A doctor or physical therapist can recommend stretches and exercises for your feet.
- Weight management: Extra weight adds stress to the bones of your feet. Try to manage your weight by maintaining a nutritious diet and getting regular exercise.
- Splint or brace: In some cases, a splint or brace may be helpful. You can talk with a doctor about this option.
- Walking cane: A walking cane can help you feel more stable.
These lifestyle strategies may help you feel better and delay the progression of OA, but they may not stop it.
Several treatment options are available for OA of the toe if lifestyle strategies aren’t working for you.
Oral or topical medications
Oral medications such as OTC NSAIDs can reduce inflammation and offer relief. A doctor may also recommend OTC topical anti-inflammatory gels or lotions.
If OTC medications aren’t effective, a doctor may recommend prescription medications.
Corticosteroid injections
A doctor can also inject corticosteroids directly into your joint to help reduce swelling and relieve pain. A single corticosteroid injection can be effective. You can receive these injections only three or four times per year.
Surgery
In more severe cases, a doctor can surgically remove damaged cartilage and fix your toe joint in a permanent position using a plate and screws or wires. This procedure is called a fusion (arthrodesis).
Some people may benefit from joint replacement surgery (arthroplasty). Surgical options will depend on your activity level and whether your activities require motion of the metatarsophalangeal joint.
If nonsurgical treatments don’t help with your OA, you can ask your doctor whether you’re a good candidate for surgery.
Here are some tips to help prevent OA of the big toe:
Manage your weight
Maintaining a healthy weight for your height can help prevent your joints from experiencing extra stress. According to the Arthritis Foundation, for every pound you gain, your knees have to support roughly 4 extra pounds of stress. Over time, this extra stress will lead to your joints breaking down.
If you have diabetes, manage your blood sugar levels
People with type 2 diabetes are almost twice as likely to have arthritis.
According to the Arthritis Foundation, recent research suggests that high blood sugar can contribute to the formation of molecules that cause cartilage to stiffen. People with diabetes also experience inflammation that can cause a loss of cartilage.
Exercise regularly
Regular exercise helps strengthen the muscles that support your joints. It also keeps your joints limber. Getting 30 minutes of physical activity 5 times per week can help prevent OA.
Take care of any injuries
You’re more likely to develop arthritis in joints that you’ve injured. To help protect your joints, you can wear protective gear when playing sports and practice good lifting techniques when carrying heavy objects.
Choose footwear that doesn’t crowd your big toe
If you’re trying to avoid OA of the big toe, it’s best to avoid shoes that squeeze or put undue pressure on your big toe, such as high heels, shoes that are too tight or narrow (particularly in the toe box), and pointy-toed pumps.
Instead, look for comfortable, well-fitting shoes that have plenty of room for your big toe (and all your other toes).
Many factors, including genetics, can contribute to the development of OA. But treatment options are available to help you manage the condition and its symptoms.
A doctor can help you create a treatment plan that works best for you.