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Hallux Rigidus—Common Causes, Symptoms & Treatment

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By Babafemi Adebajo
Michelle Meyer - Editor for Upstep
Edited by Michelle Meyer

Updated December 22, 2022.

A woman's foot with a clear bulge on the bone of her big toe, with red nail varnish on her toenails,

Hallux rigidus quite literally translates to a rigid big toe. It’s a type of degenerative arthritis that affects the metatarsophalangeal (MTP) joint of your big toe, causing significant pain and stiffness that progressively worsens, making it difficult to bend your toe. This can affect how you stand, walk, or climb.

Causes of Hallux Rigidus

Hallux rigidus occurs when the articular cartilage at the end of your MTP joint wears off and your bones begin to rub against one another directly. With the cartilage damaged, a bony spur forms around your toe's base. The bony outgrowth then begins to limit motion at your MTP joint. Specific causes that can set this in motion include;

  • Abnormal Foot Anatomy Abnormalities in foot anatomy such as displaced sesamoid bones and a long or elevated first metatarsal bone increase your risk of developing a stiff big toe.
  • Certain Medical Conditions Inflammatory joint diseases like gout, psoriatic arthritis, rheumatoid arthritis, and osteoarthritis of the first MTP can all lead to hallux rigidus.
  • Injuries Past trauma to your big toes such as the turf toe (caused by the hypertension of your big toe) or a stubbed toe can increase your risk of hallux rigidus.
  • Strain Due to Overuse Repeatedly placing strain on your MTP joint during strenuous physical activities like ballet dancing, climbing, or constant stooping and squatting can lead to toe stiffness.
  • Genetics Genetics sometimes determines foot shape, foot type, and even gait. Therefore, you have a higher chance of developing hallux rigidus if other member of your family have the condition.

Common Symptoms

Hallux rigidus often starts as hallux limitus (your big toes are less stiff). As it progresses, it may mimic the symptoms of hallux valgus (bunions). However, it's essential to know the difference between bunions and bone spurs (like hallux rigidus) to treat them properly.

The common symptoms of hallux rigidus include:

Early Symptoms

  • Pain and stiffness in your big toe that worsens with use (walking, squatting, bending, climbing, etc.)
  • Pain and stiffness worsened by cold, damp weather
  • Difficulty with mobility
  • Swelling, warmth, and tenderness around your toe's joint

Additional Symptoms

  • Pain at rest
  • Reduced range of motion of your big toe, preventing bending
  • Bony spur on top of your feet
  • Limping in extreme cases
  • Dull pain in the hip, knee, or lower back due to altered gait
  • Formation of bunions and calluses that can make your regular shoes uncomfortable

Treatment of Hallux Rigidus

The longer you leave hallux rigidus unattended, the more pain and functionality impairment increase. The correct treatment will help to stop the progression of symptoms. Below are at-home and surgical treatments you can consider.

At-Home Treatment Methods

  • Wear appropriate shoes Avoid any shoes where your toes have to grip like high heels and open-heel shoes. Instead, opt for shoes with adequate toe space and thick, curved, stiff soles that help with pain relief.
  • Soak your feet Alternate soaking your feet in hot and cold water. You can also use heat or ice packs. The difference in temperature will help to relieve pain.
  • Avoid high-impact activities High-impact activities like jumping and jogging can place undue stress on your MTPs, increasing your pain, so make sure you avoid them.
  • Seek medical guidance on medication/injections Medication like ibuprofen, platelet-rich plasma, and corticosteroid injections can help relieve pain. Ask your medical doctor which medications or injections are best for you to take, making sure any allergies, conflicting medication, and underlying issues are taken into account.
  • Invest in custom orthotics A podiatrist can design custom orthotics for you that will limit motion at your MTP joint and prevent abnormal foot motion, leading to pain relief.

Hallux rigidus can eventually develop into metatarsalgia and spread pain into the ball of your foot. If you're an athlete or lead any type of active lifestyle, make sure you give your feet proper support through custom orthotics.

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Surgical Treatments

If the pain begins to interfere with your daily activities, you may have to consider surgery. Possible surgical approaches to treating hallux rigidus include:

  • Arthrodesis: This fuses the metatarsals with the phalanges, removing the cartilage between them.
  • Arthroplasty: This is a joint replacement surgery where one or both of the articulating bone heads is replaced with plastic or metal.
  • Cheilectomy: With mild to moderate damage, you can shave bony spurs off.
  • Interpositional Arthroplasty: After removing some of the damaged cartilage, the surgeon will place a spacer between the bones to limit contact between them.

Bottom Line

If you have any cause to suspect that the pain or stiffness in your feet suggests hallux rigidus, don’t wait to start treatment. The most effective and simplest way to invest in your feet is by purchasing custom orthotics to relieve your symptoms.

Want to get started? Check out Upstep’s collection of medical-grade orthotics to improve your foot health and keep you as pain-free as possible.

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