Hallux rigidus is a form of arthritis that affects the primary joint of the big toe located in the ball of the foot. As the joint surfaces wear out, stiffness (“rigidus”) develops in the big toe (“hallux”), which is the hallmark feature of this condition. In some individuals, only the upper part of the joint degenerates; in others, the entire joint becomes arthritic.
What Causes Hallux Rigidus?
For most people, there is no clear cause. The big toe joint endures significant stress—each step places pressure equal to twice your body weight on this small joint—making it prone to degeneration.
In some cases, injuries, infections, or medical conditions like gout may trigger arthritis in the joint. Although several theories exist about why the joint becomes arthritic, none definitively explain the cause or offer reliable prevention.
What Problems Can It Cause?
The most common issue is pain in the big toe joint. Some people feel pain with every step or even while resting, while others have discomfort only when the toe is bent upward.
Stiffness is also typical, affecting the ability to lift the big toe while still allowing downward movement. In severe cases, the toe may become fixed in a downward position.
A bony bump (osteophyte or “dorsal bunion”) may form on the top of the joint as the body responds to joint wear. This bump often rubs against shoes, sometimes becoming the only noticeable symptom.
Shifting weight to the outer border of the foot—due to toe pain—can cause discomfort in the ball or along the side of the foot. Uneven wear can also make the big toe drift toward the second toe, causing them to rub.
Why Does It Occur in Young People?
Hallux rigidus is known to begin early—even in teenage years. The exact reason remains unknown. The good news is that most people do not experience rapid worsening, and the condition does not significantly increase the likelihood of arthritis in other joints such as the knee or hip.
Will It Get Worse Over Time?
Long-term studies show that while the joint remains arthritic and stiff, progression is typically slow. Even after two decades, the condition often looks the same as when first diagnosed.
However, about 20–25% of people may experience worsening stiffness or pain that eventually requires treatment.
Can I Prevent It from Getting Worse?
General health measures are beneficial:
- Stay active and maintain overall fitness
- Avoid excess weight
- Choose comfortable, well-fitting footwear
Unfortunately, there is no specific action proven to prevent progression.
What Treatments Are Available?
Pain-relieving medications such as paracetamol are often helpful. If pain persists, a doctor may prescribe stronger painkillers or anti-inflammatory drugs when appropriate.
Since pain is usually triggered when bending the toe upward during walking, stiffening the shoe’s sole may help. A rocker bar under the shoe can reduce the need for the toe to bend. An orthotist or chiropodist can modify your footwear accordingly. However, stiff insoles can sometimes push the bone bump upward against the shoe, causing irritation.
A steroid injection combined with local anaesthetic may reduce inflammation and pain. The injection is usually done in the outpatient clinic. Relief may last from days to months and is occasionally permanent.
Is Surgery an Option?
If conservative measures fail, surgery can be beneficial. The choice of procedure depends on the extent of arthritis and should be decided by a foot and ankle surgeon.
- Cheilectomy (Minimally Invasive / Keyhole Surgery):
If only the upper portion of the joint is affected, the arthritic bone and spurs can be trimmed. This improves motion and reduces pain. Around 75% of patients experience long-term improvement, though some may eventually require further procedures as arthritis progresses. - Joint Fusion (Arthrodesis):
When the entire joint is worn out, fusion is often recommended—especially for younger, active individuals or those with heavy physical jobs. Fusion eliminates pain in up to 95% of cases but results in a permanently stiff toe. Shoe options may become somewhat limited. A small number may later develop arthritis in nearby joints, though this is rarely problematic.