Hallux Rigidus: How to Alleviate Big Toe Pain

Condition • By Biraj Patel

Hallux rigidus is a type of arthritis that affects the big toe joint, making it stiff and painful to move. It is the most common arthritic condition of the foot, affecting 1 in 40 people over the age of 50. The condition can be very troubling and even disabling since we use the big toe whenever we walk, stoop down, climb up, or even stand.

What is hallux rigidus?

Hallux rigidus, often referred to as big toe arthritis, a term that may sound quite imposing, is, in simple terms, a condition that affects the big toe – your largest and most essential toe. Specifically, it's a form of arthritis that takes root in the metatarsophalangeal joint (MTP), the joint located at the base of the big toe. This joint allows your big toe to bend upward and play its part in walking, running, and various daily activities.

However, when hallux rigidus sets in, this joint becomes stiff, making it increasingly challenging to move your big toe as you normally would. This stiffness, which often develops gradually, is primarily due to the wear and tear of the joint's protective cartilage. And, as with most things in life, wear and tear come with their fair share of pain, swelling, and restricted movement.

So, in essence, hallux rigidus is like a hiccup in your big toe's usual smooth functioning, causing discomfort and inconvenience.

Hallux rigidus causes

The primary cause of hallux rigidus is the gradual degeneration of the metatarsophalangeal joint. This degeneration can occur due to a variety of factors, including:

A long or elevated first foot bone or other differences in foot anatomy
Prior injury to the big toe
Family history
Faulty function (biomechanics) and structural abnormalities of the foot that can lead to osteoarthritis in the big toe joint
Overuse, especially among people engaged in activities or jobs that increase the stress on the big toe, such as workers who often must stoop or squat
Inflammatory diseases, such as rheumatoid arthritis or gout

Hallux rigidus symptoms

The symptoms of hallux rigidus can vary and may include one or more of the following:

Pain and stiffness in the joint at the base of the big toe when walking, standing, or bending
Reduced range of motion
Swelling or inflammation around the joint
Difficulty bending the toe up and down
Walking on the outside of the foot due to pain in the big toe
Bony bump on the top of the foot

Hallux rigidus stages

Hallux rigidus typically progresses through several stages, from mild to severe. These stages help determine the most suitable treatment options.

Stage 1: Mild stiffness and pain in the joint, especially during or after physical activity.
Stage 2: Increased pain and stiffness, with decreased range of motion.
Stage 3: Severe pain and stiffness, with little or no range of motion.

How to prevent hallux rigidus

Preventing hallux rigidus is not always possible, but there are some things you can do to reduce your risk of developing the condition:

Wear shoes that fit well and have a wide and deep toe box to reduce pressure on the big toe joint.
Avoid high-impact activities that put stress on the big toe joint, such as running or jumping.
Maintain a healthy weight to reduce the stress on your feet and toes.
Stretch your feet and toes regularly to improve flexibility and reduce the risk of injury.
If you have a family history of hallux rigidus or other foot problems, talk to your healthcare provider about ways to reduce your risk.

It's important to note that early diagnosis and treatment of hallux rigidus can help prevent the condition from getting worse. If you experience any hallux rigidus symptoms, such as pain and stiffness in the big toe joint, reduced range of motion, or swelling, see your orthopedic specialist for a diagnosis and treatment plan.

Hallux rigidus treatment

Now, let's delve into the crucial part of this article – the hallux rigidus treatment. The choice of treatment largely depends on the stage of the condition.

For early-stage hallux rigidus (stages 1 and 2), conservative approaches include orthotic devices and proper footwear, medications, and physical therapy.

Orthotic devices and hallux rigidus shoes

Custom-made insoles can help redistribute pressure on the joint. The choice of footwear is essential for managing hallux rigidus. Opt for shoes with:

A roomy toe box to accommodate the big toe joint.
Good arch support to maintain proper foot alignment.
Shock-absorbing soles to reduce impact on the joint.

Hallux rigidus exercises

Engaging in specific exercises can be a beneficial part of managing hallux rigidus. These exercises aim to maintain joint flexibility and strength. Here are some hallux rigidus exercises you may consider.

Toe stretches

Sit or stand comfortably.
Use your hand to gently pull your big toe upwards, stretching it away from the other toes.
Hold the stretch for 15–30 seconds.
Release and repeat several times.

Toe raises

Sit in a chair with your feet flat on the ground.
Lift your big toe while keeping the other toes on the ground.
Hold for a few seconds, then lower it.
Perform 10–15 repetitions.

Marble pickup

Place a few marbles on the floor.
Sit in a chair with your feet flat.
Use your toes to pick up the marbles and place them in a bowl.
Repeat this exercise for 5–10 minutes.

Towel scrunch

Place a small towel flat on the floor.
Sit in a chair and use your toes to scrunch up the towel.
Release and repeat for several minutes.

Ankle alphabet

Sit or lie down with your leg extended.
Imagine your big toe as a pen and write the alphabet in the air with your big toe.
This exercise helps improve range of motion in the joint.

Resistance band exercises

Sit with your leg extended.
Wrap a resistance band around your big toe.
Gently flex and extend your big toe against the resistance of the band.
Perform 10–15 repetitions.

These exercises should be performed gently and without causing pain. They aim to maintain the flexibility of the big toe joint and strengthen the surrounding muscles. However, it's essential to consult with an orthopedic specialist or physical therapist to ensure that you're performing the right exercises for your specific stage of hallux rigidus and to receive guidance on the appropriate level of intensity and repetitions.

Medications

Non-steroidal anti-inflammatory drugs (NSAIDs) can help manage pain and inflammation. Platelet-rich plasma injections and similar injections into the joint are promising.

Hallux rigidus surgery

If non-surgical treatments do not relieve the symptoms, surgery may be necessary. The type of surgery depends on the stage of the condition and the severity of the symptoms:

Cheilectomy: This is a surgical procedure that removes bone spurs and a portion of the foot bone to increase the range of motion in the joint. This procedure is most effective in the early stages of hallux rigidus.
Arthrodesis: This is a surgical procedure that fuses the bones of the joint together, eliminating the joint and reducing pain. This procedure is most effective in the later stages of hallux rigidus.
Arthroplasty: This is a surgical procedure that replaces the joint with an artificial joint. This procedure is most effective in older patients who place few functional demands on the feet.

Discuss hallux rigidus treatment with the best orthopedic surgeons on PreferredMD

Hallux rigidus is a challenging condition that can significantly impact your daily life. Understanding its causes, recognizing symptoms, and choosing the right treatment can make a world of difference.

Remember, early intervention and proper care can help you regain comfort and mobility in your big toe. If you're in doubt, consult with a trusted orthopedic surgeon to explore the best course of action tailored to your unique needs. Your big toe, and your future self, will thank you.