Stiff Big Toe Joint: A Comprehensive Guide to Hallux Rigidus
11 July 2026
By Mark Reyneker, B.T. Pod (SA), MSc (SA) Registered Podiatrist & Human Gait Specialist Founder / Clinical Director, Family Podiatry Centre
Published: 11 July 2026 | Last reviewed: 11 July 2026
Introduction: when the big toe becomes stiff, painful and difficult to bend
Pain and stiffness in the big toe joint can make ordinary walking surprisingly difficult. Many people first notice the problem when walking uphill, climbing stairs, running, lunging, squatting, wearing formal shoes or pushing off during exercise. The joint may feel tight, swollen, enlarged or painful on top. Over time, a hard bony bump may develop over the big toe joint and shoes may begin to rub.
This condition is commonly known as hallux rigidus, or arthritis of the big toe joint.
Although hallux rigidus is often described as “wear and tear”, that explanation is too simplistic. From a podiatric perspective, hallux rigidus usually develops through a combination of cartilage damage, altered first-ray mechanics, joint shape, previous injury, footwear stress, bone spur formation and changes in walking pattern.
The good news is that many patients can reduce pain and improve function without immediately considering surgery. The key is understanding why the joint is painful, how the big toe behaves during walking, and how to reduce painful compression through better footwear, orthotic support and sensible exercises.
What is hallux rigidus?
Hallux rigidus is a degenerative arthritic condition affecting the first metatarsophalangeal joint. This is the joint between the first metatarsal bone and the base of the big toe.
The word hallux means big toe. Rigidus means stiff.
In hallux rigidus, the joint gradually loses normal movement. The cartilage may become thinner or damaged, the joint space may narrow, the joint capsule may thicken, and bone spurs may form around the joint. These changes can make the big toe painful when it bends upwards during walking.
Typical features include:
- pain at the base of the big toe;
- stiffness during walking;
- swelling around the joint;
- reduced ability to bend the toe upwards;
- pain during push-off;
- a bony bump on top of the joint;
- difficulty wearing shoes;
- pain in flexible shoes;
- altered walking pattern; and
- progressive loss of joint motion.
Hallux rigidus is one of the most common arthritic problems of the foot and can significantly affect walking, exercise and quality of life (Bergin et al., 2012; Roddy et al., 2015).
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Hallux rigidus, hallux limitus and functional hallux limitus
These terms are related but not identical.
Hallux limitus
Hallux limitus
Hallux limitus means limited movement of the big toe joint. The joint may be stiff, painful or mechanically restricted, but it may not yet have advanced arthritis.
Hallux rigidus usually refers to a more established arthritic condition where stiffness is associated with structural joint changes such as cartilage loss, joint-space narrowing and bone spur formation.
Functional hallux limitus describes a situation where the big toe appears to move reasonably well when the foot is relaxed, but fails to bend properly when the person stands or walks.
This is clinically important because a patient may say, “My toe bends when I pull it up with my hand, so why does it hurt when I walk?” The answer is that the joint may behave very differently under body weight.
This is clinically important because a patient may say, “My toe bends when I pull it up with my hand, so why does it hurt when I walk?” The answer is that the joint may behave very differently under body weight.
Dananberg (1993) described functional hallux limitus as a gait-related restriction of first metatarsophalangeal joint motion. Roukis, Scherer and Anderson (1996) showed that the position of the first ray affects big toe joint movement. Van Gheluwe et al. (2006) demonstrated that hallux limitus changes plantar pressure and foot motion during walking.
From a podiatric viewpoint, this distinction is essential. The important question is not only how much the toe bends while sitting. The more important question is whether the big toe joint can move efficiently when the body passes over the foot during walking.
Why the big toe joint is so important
The big toe joint is small, but it has a major role in walking and propulsion.
During walking, the heel contacts the ground, the foot accepts body weight, the body moves forwards, and the heel lifts. As the heel rises, the big toe must bend upwards. This movement is called dorsiflexion.
For efficient walking, the big toe joint needs:
- adequate dorsiflexion;
- smooth cartilage;
- good sesamoid movement;
- stable first-ray mechanics;
- appropriate plantar fascia tension;
- adequate ankle mobility;
- suitable footwear; and
- coordinated muscle control.
The joint does not work as a simple hinge. It rolls, glides, rotates and compresses. The first metatarsal also needs to plantarflex slightly during propulsion so that the big toe can dorsiflex over it.
If the first metatarsal remains too elevated, if the joint is blocked by bone spurs, or if the foot mechanics prevent normal gliding, the big toe joint may jam during push-off. Repeated jamming is one of the central podiatric concepts in hallux rigidus.
If the first metatarsal remains too elevated, if the joint is blocked by bone spurs, or if the foot mechanics prevent normal gliding, the big toe joint may jam during push-off. Repeated jamming is one of the central podiatric concepts in hallux rigidus.
What happens inside the joint?
Hallux rigidus involves osteoarthritic change within the first metatarsophalangeal joint.
These changes may include:
- thinning of articular cartilage;
- roughening of the cartilage surface;
- inflammation of the synovial lining;
- thickening of the joint capsule;
- subchondral bone stress;
- subchondral sclerosis;
- cyst formation;
- flattening of the first metatarsal head;
- dorsal bone spur formation;
- reduced sesamoid movement;
- pain at end-range dorsiflexion; and
- progressive loss of movement.
MRI research confirms that first metatarsophalangeal joint osteoarthritis may involve cartilage loss, bone marrow lesions, subchondral cysts, osteophytes, synovitis and joint-space narrowing (Munteanu et al., 2021).
This means hallux rigidus is not simply a “bone spur problem”. The bone spur is often the visible part of the condition, but the underlying disease can involve the entire joint.
The pathogenesis of hallux rigidus: how the condition develops
Hallux rigidus often develops through a chain reaction.
Step 1: the joint becomes vulnerable
The joint may become vulnerable because of inherited structure, previous trauma, abnormal first-ray mechanics, joint shape, repetitive loading, inflammatory disease or footwear compression.
Step 2: cartilage becomes irritated or damaged
The cartilage may be injured by trauma, repetitive compression or abnormal loading. Once the cartilage surface becomes less smooth, the joint becomes less able to distribute pressure evenly.
The cartilage may be injured by trauma, repetitive compression or abnormal loading. Once the cartilage surface becomes less smooth, the joint becomes less able to distribute pressure evenly.
Step 3: dorsal impingement begins
During push-off, the base of the big toe may contact the top of the first metatarsal head too early. This creates dorsal joint compression and pain at the top of the joint.
Step 4: bone spurs form
During push-off, the base of the big toe may contact the top of the first metatarsal head too early. This creates dorsal joint compression and pain at the top of the joint.
Step 4: bone spurs form
The body responds to abnormal joint stress by forming osteophytes, or bone spurs. These may begin as a stabilising response, but they eventually make the joint more painful and more restricted.
Step 5: stiffness creates more stiffness
Pain causes the patient to avoid normal big toe motion. The joint capsule thickens, the sesamoids glide less effectively, and the joint becomes stiffer. As the joint stiffens, it jams earlier during walking.
Step 6: walking pattern changes
Step 6: walking pattern changes
The patient may start rolling to the outside of the foot, turning the foot out, shortening the stride or avoiding toe-off. This may reduce pain temporarily, but it can create secondary overload elsewhere in the foot.
This self-reinforcing cycle explains why hallux rigidus may gradually progress from mild stiffness to significant arthritis.
This self-reinforcing cycle explains why hallux rigidus may gradually progress from mild stiffness to significant arthritis.
What causes hallux rigidus?
Hallux rigidus is multifactorial. There is rarely one single cause.
1. Family history and inherited joint structure
Coughlin and Shurnas (2003a) found that bilateral hallux rigidus was commonly associated with family history, while unilateral disease was more often associated with trauma.
This suggests that inherited factors may influence:
- first metatarsal head shape;
- joint congruity;
- cartilage resilience;
- first-ray alignment;
- sesamoid position;
- hallux length;
- ligament stiffness; and
- the way the foot loads during gait.
A patient may therefore inherit a foot structure that makes the big toe joint more vulnerable to arthritis.
2. Previous injury
Trauma is especially important when hallux rigidus affects one foot more than the other.
Relevant injuries may include:
- severe stubbing of the big toe;
- turf-toe injury;
- hyperextension injury;
- direct impact;
- fracture involving the joint;
- cartilage injury;
- sesamoid injury; or
- repetitive sports-related jamming.
A single injury may damage the cartilage surface. Once cartilage is damaged, the joint may no longer distribute force evenly, leading to inflammation, stiffness and bone spur formation.
3. Repetitive compression during push-off
Every step loads the big toe joint. Walking, running, climbing, lunging and squatting all require the joint to tolerate compression and dorsiflexion.
3. Repetitive compression during push-off
Every step loads the big toe joint. Walking, running, climbing, lunging and squatting all require the joint to tolerate compression and dorsiflexion.
Repetitive loading does not automatically cause hallux rigidus. Many active people never develop big toe arthritis. The problem occurs when repetitive loading acts on a joint that is already mechanically vulnerable.
A joint may be vulnerable because of:
A joint may be vulnerable because of:
- reduced first-ray plantarflexion;
- metatarsus primus elevatus;
- previous cartilage injury;
- limited ankle dorsiflexion;
- poor footwear;
- joint incongruity; or
- functional hallux limitus.
In these cases, repeated push-off may become repeated impingement.
4. Metatarsus primus elevatus
Metatarsus primus elevatus means the first metatarsal sits higher than expected relative to the lesser metatarsals.
Metatarsus primus elevatus means the first metatarsal sits higher than expected relative to the lesser metatarsals.
This has long been discussed in podiatry as a possible cause of hallux rigidus. The theory is that if the first metatarsal sits too high, the big toe has less room to dorsiflex over it. The joint jams, the dorsal cartilage becomes overloaded, and bone spurs develop.
However, the evidence is debated.
However, the evidence is debated.
Horton, Park and Myerson (1999) challenged the idea that metatarsus primus elevatus is always the primary cause. Roukis (2005), in a Journal of the American Podiatric Medical Association review, concluded that metatarsus primus elevatus is seen in hallux rigidus but that its exact role remains uncertain. Other studies have found evidence supporting an association between first metatarsal elevation and hallux rigidus (Bouaicha et al., 2010; Anwander et al., 2022; Lee et al., 2023).
The most balanced interpretation is that metatarsus primus elevatus may be a cause in some patients, a consequence in others, and part of a bidirectional cycle in many.
5. First-ray instability or poor first-ray timing
The first ray includes the first metatarsal and associated medial column structures.
During walking, the first ray must become stable enough for propulsion but mobile enough to adapt. If the first ray dorsiflexes too easily under load, the big toe may be forced to bend against a metatarsal that has moved upwards. This can reduce functional dorsiflexion and increase dorsal joint compression.
This is one reason why not every patient with hallux rigidus should simply stretch the big toe harder. Some patients need better first-ray loading, improved shoe structure or orthotic control.
6. Soft-tissue restriction
Bone is not the only factor. Soft tissues may also restrict big toe motion.
This is one reason why not every patient with hallux rigidus should simply stretch the big toe harder. Some patients need better first-ray loading, improved shoe structure or orthotic control.
6. Soft-tissue restriction
Bone is not the only factor. Soft tissues may also restrict big toe motion.
Possible contributors include:
- plantar fascia tension;
- capsular tightness;
- flexor hallucis longus restriction;
- sesamoid restriction;
- intrinsic muscle dysfunction;
- calf tightness;
- limited ankle dorsiflexion; and
- protective muscle guarding.
Durrant and Siepert (1993) discussed soft-tissue structures as possible contributors to hallux limitus. These structures may increase resistance to dorsiflexion and contribute to joint jamming.
7. Abnormal first metatarsal head shape
7. Abnormal first metatarsal head shape
Some first metatarsal heads are rounded. Others are flatter, squarer or less congruent.
A flatter or irregular joint surface may:
- reduce smooth gliding;
- concentrate pressure;
- increase dorsal impingement;
- reduce tolerance to trauma; and
- encourage osteophyte formation.
The difficulty is that arthritis itself can change the shape of the metatarsal head. Therefore, it is not always possible to know whether the shape caused the arthritis or developed because of it.
8. Hindfoot valgus and pronation
Pronated foot posture and hindfoot valgus can change how the first ray loads during walking. Mahiquez, Wilder and Stephens (2006) found a relationship between positive hindfoot valgus and osteoarthritis of the first metatarsophalangeal joint.
This does not mean every flat foot causes hallux rigidus. Many people with flat feet never develop big toe arthritis, and many people with hallux rigidus do not have flat feet.
The more precise podiatric interpretation is that some foot postures may alter first-ray function and increase the mechanical demand on the big toe joint.
9. Footwear
Footwear may not be the sole cause of hallux rigidus, but it can strongly influence symptoms.
Shoes that commonly aggravate the condition include:
Shoes that commonly aggravate the condition include:
- narrow shoes;
- shallow toe-box shoes;
- high heels;
- very flexible shoes;
- minimalist shoes;
- thin-soled shoes;
- shoes that bend directly under the painful joint;
- shoes that are too short; and
- shoes that rub the dorsal bone spur.
In early hallux rigidus, footwear may determine whether the joint is comfortable or painful.
10. Inflammatory or metabolic joint disease
Not every stiff big toe is ordinary osteoarthritis.
Not every stiff big toe is ordinary osteoarthritis.
Other possible causes include:
- gout;
- rheumatoid arthritis;
- psoriatic arthritis;
- infection;
- osteochondral injury;
- sesamoiditis;
- stress fracture; and
- previous surgical complications.
A red, hot, acutely swollen big toe joint should be assessed promptly.
Symptoms of hallux rigidus
Common symptoms include:
- pain at the base of the big toe;
- stiffness during walking;
- pain during push-off;
- swelling around the joint;
- a hard bump on top of the joint;
- difficulty wearing shoes;
- pain in flexible footwear;
- discomfort walking uphill;
- difficulty with lunges or squats;
- pain after running or long walks;
- grinding or clicking;
- reduced stride length;
- walking on the outside of the foot;
- callus beneath the lesser metatarsals; and
- pain under the ball of the foot.
In early hallux rigidus, pain is often felt at the top of the joint when the toe is forced upwards. In advanced hallux rigidus, pain may occur throughout the available range of movement or even at rest.
Why the top of the big toe joint becomes painful
The top of the joint is commonly painful because this is where dorsal impingement occurs.
As the heel lifts during walking, the big toe needs to bend upwards. If the joint does not glide properly, the base of the toe collides with the top of the first metatarsal head. This may cause:
- cartilage compression;
- synovial irritation;
- capsular inflammation;
- bone spur formation;
- shoe rubbing; and
- pain when the toe is pushed upwards.
This explains why patients often feel worse in shoes that bend easily through the forefoot.
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How hallux rigidus changes walking
Hallux rigidus can affect the whole walking pattern.
Canseco et al. (2008) demonstrated measurable changes in foot and ankle kinematics in patients with hallux rigidus. Stevens et al. (2022) found that symptomatic hallux rigidus affects sagittal hallux motion and that the forefoot may compensate with increased supination during push-off.
Common compensations include:
- turning the foot out;
- rolling over the outside of the foot;
- shortening the stride;
- reducing walking speed;
- lifting the heel early;
- avoiding big toe push-off;
- increasing pressure beneath the lesser toes;
- increasing lateral forefoot load;
- changing ankle motion; and
- developing secondary discomfort elsewhere.
This is why a podiatric assessment should examine more than the big toe. The rest of the foot, ankle, calf, footwear and gait pattern all matter.
How hallux rigidus is diagnosed
Diagnosis usually begins with clinical assessment.
A podiatric examination may include:
- location of pain;
- duration of symptoms;
- whether one or both feet are affected;
- history of trauma;
- family history;
- current footwear;
- occupation and activity level;
- passive joint range of motion;
- active joint range of motion;
- pain at end range;
- pain through the whole range;
- crepitus;
- swelling;
- dorsal osteophytes;
- sesamoid tenderness;
- first-ray mobility;
- ankle dorsiflexion;
- calf flexibility;
- foot posture;
- plantar callus pattern;
- gait assessment; and
- shoe wear pattern.
Weightbearing X-rays
Weightbearing X-rays are often useful because hallux rigidus is a load-related condition.
X-rays may show:
- joint-space narrowing;
- dorsal osteophytes;
- flattening of the metatarsal head;
- subchondral sclerosis;
- cyst formation;
- loose bodies;
- sesamoid arthritis;
- metatarsus primus elevatus; and
- alignment changes.
X-rays should always be interpreted alongside symptoms. Some patients have significant X-ray changes but mild symptoms. Others have moderate X-ray changes but substantial pain due to inflammation or mechanical irritation.
MRI or CT
MRI or CT
MRI may be useful when symptoms are disproportionate to X-ray findings, or when cartilage injury, bone marrow lesions, synovitis, sesamoid pathology or stress injury is suspected.
Weightbearing CT may help evaluate three-dimensional joint alignment and first metatarsal elevation in complex cases.
Stages of hallux rigidus
The Coughlin and Shurnas grading system is commonly used and considers joint motion, X-ray findings and symptoms (Coughlin and Shurnas, 2003b).
Early hallux rigidus
Early hallux rigidus may involve mild stiffness, pain at the end of dorsiflexion and small dorsal osteophytes.
Moderate hallux rigidus
Moderate hallux rigidus often involves more obvious restriction, larger bone spurs, joint-space narrowing and pain during walking or exercise.
Advanced hallux rigidus
Advanced hallux rigidus may involve severe stiffness, extensive cartilage loss, pain through the range of movement, sesamoid arthritis and significant difficulty with daily activities.
The stage matters because treatment differs. A mildly stiff joint with functional jamming is managed differently from an end-stage arthritic joint with pain throughout movement.
Simple home treatment for hallux rigidus
The aim of home care is not to force an arthritic joint to bend aggressively. The aim is to reduce painful compression, calm irritation and improve the mechanics around the joint.
This simple plan is suitable for mild to moderate symptoms. It should be stopped if pain worsens significantly.
Step 1: change your shoes to reduce big toe joint bending
For two to four weeks, use shoes that reduce painful dorsiflexion at the big toe joint.
Look for shoes with:
- a stiff forefoot sole;
- a mild rocker sole;
- a wide toe box;
- a deep toe box;
- enough length in front of the toes;
- a stable heel counter;
- reduced forefoot twisting; and
- no pressure over the dorsal bump.
Avoid, at least temporarily:
- high heels;
- narrow formal shoes;
- shallow toe-box shoes;
- very flexible shoes;
- thin minimalist shoes;
- unsupportive slippers;
- shoes that bend sharply under the big toe joint; and
- shoes that rub the top of the joint.
A practical test is to hold the shoe and try to bend it. If it folds easily at the painful big toe joint, it may aggravate hallux rigidus. A shoe that bends less through the forefoot, or rolls forwards through a rocker sole, often feels better.
Carbon-fibre shoe-stiffening inserts have also been studied. Munteanu et al. (2021) found that carbon-fibre shoe-stiffening inserts were more effective than sham inserts for reducing pain in people with first metatarsophalangeal joint osteoarthritis over 12 weeks.
Step 2: gentle pain-free big toe mobilisation
This exercise is for gentle movement, not forceful stretching.
Sit down and hold the first metatarsal steady with one hand. With the other hand, gently move the big toe up and down within a comfortable range.
Perform:
- 10 slow repetitions;
- one to two sets;
- once daily;
- no forcing into sharp pain.
The aim is to maintain comfortable motion and reduce guarding. If the joint feels more painful afterwards, reduce the range or stop.
This is most suitable when the joint still has some movement and pain is mainly at end range. It is not appropriate to aggressively mobilise a severely arthritic, swollen or acutely inflamed joint.
Step 3: short-foot arch activation
This exercise helps improve intrinsic foot control and first-ray stability without curling the toes.
Sit or stand with the foot flat. Keep the heel and forefoot on the ground. Gently draw the ball of the foot slightly towards the heel, as if shortening the arch. The toes should stay relaxed and should not claw.
Hold for five seconds, then relax.
Perform:
- 8 to 12 repetitions;
- one to two sets;
- once daily.
The aim is to improve medial arch control and foot stability. This may help some people reduce excessive collapse or poor loading through the first ray.
Step 4: calf and ankle mobility wall stretch
Limited ankle dorsiflexion can increase forefoot loading and encourage early heel lift. Improving calf and ankle mobility may reduce stress through the big toe joint during walking.
Stand facing a wall. Place the affected foot behind you. Keep the heel down and knee straight. Lean forwards until you feel a comfortable calf stretch.
Hold for 20 to 30 seconds.
Then repeat with the back knee slightly bent to target the deeper calf muscles.
Perform:
- two repetitions with the knee straight;
- two repetitions with the knee bent;
- once daily.
This should feel like a calf stretch, not big toe joint pain. If the big toe joint is irritated in this position, adjust the foot position or stop.
When home care is not enough
Home treatment may help symptoms, but it does not reverse advanced cartilage loss.
A podiatric assessment is recommended if:
- pain persists beyond two to four weeks;
- the joint is swollen;
- the toe is becoming progressively stiffer;
- there is a visible bony bump;
- footwear is becoming difficult;
- pain affects work or exercise;
- symptoms started after trauma;
- the joint is red, hot or acutely inflamed;
- pain is present at rest;
- there is numbness or burning;
- you are diabetic;
- you have inflammatory arthritis; or
- you are unsure whether the diagnosis is hallux rigidus.
Podiatric treatment for hallux rigidus
Treatment depends on the stage of disease, pain pattern, joint motion, footwear, activity goals and foot mechanics.
Footwear advice
Footwear is often the first treatment step. The podiatric goal is to reduce painful motion, reduce dorsal pressure and improve propulsion.
Helpful footwear features may include:
- rocker sole;
- stiff forefoot sole;
- wide toe box;
- deep toe box;
- adequate shoe length;
- soft upper over the dorsal joint;
- stable midsole;
- reduced forefoot flexion; and
- enough space for orthoses if needed.
Orthoses
Orthoses can be useful, but the design must match the patient.
For early functional hallux limitus, the goal may be to improve first-ray function and reduce jamming.
For early functional hallux limitus, the goal may be to improve first-ray function and reduce jamming.
For established hallux rigidus, the goal may be to restrict painful dorsiflexion and offload the arthritic joint.
Orthotic options may include:
- first-ray cut-out modifications;
- kinetic wedge-style modifications;
- Morton’s extension;
- reverse Morton’s extension;
- carbon-fibre plate;
- rocker-supportive orthotic designs;
- arch support to improve first-ray timing; and
- custom orthoses when mechanics are more complex.
A retrospective JAPMA study of 772 patients with symptomatic hallux limitus found that 55% were successfully treated with conservative care alone, with orthoses used in many successful cases (Grady et al., 2002).
This does not mean one orthotic works for every patient. It means conservative podiatric treatment can be helpful when matched to the patient’s mechanics.
This does not mean one orthotic works for every patient. It means conservative podiatric treatment can be helpful when matched to the patient’s mechanics.
Joint injections
In some cases, injection therapy may be used to reduce inflammation and pain. This may include corticosteroid injection or other injectable options depending on clinical assessment.
Injections may reduce symptoms, but they do not correct the underlying joint mechanics or regrow lost cartilage. They are usually considered part of a broader management plan.
Injections may reduce symptoms, but they do not correct the underlying joint mechanics or regrow lost cartilage. They are usually considered part of a broader management plan.
Activity modification
Activity does not always need to stop. However, painful loading may need to be modified.
Activities that often aggravate hallux rigidus include:
Activities that often aggravate hallux rigidus include:
- hill running;
- sprinting;
- lunges;
- deep squats;
- barefoot exercise;
- jumping;
- burpees;
- kneeling with the toe bent;
- climbing steep stairs;
- wearing flexible training shoes; and
- long walks in unsuitable footwear.
Useful substitutions may include cycling, swimming, rowing, SkiErg, strength training with modified foot position, or walking in rocker-soled shoes.
The aim is not inactivity. The aim is intelligent load management.
Can hallux rigidus be cured?
It depends what is meant by “cured”.
If hallux rigidus is early and mostly functional, symptoms may improve substantially with better shoes, orthoses, mobility work and load management.
If cartilage has already been lost and the joint has structural arthritis, conservative treatment may reduce pain and improve function, but it is unlikely to restore a completely normal joint.
Treatment can still be successful even if an X-ray continues to show arthritis. The goal is often to make the joint comfortable and functional, not to make it look perfect on imaging.
Can exercises reverse hallux rigidus?
Exercises can help selected patients, especially when stiffness is partly related to soft tissue, calf tightness, poor foot control or protective guarding.
However, exercises cannot reliably reverse advanced cartilage loss, large osteophytes or severe joint-space narrowing.
Forceful stretching of an arthritic big toe joint can sometimes make symptoms worse. The key is matching the exercise to the stage of the condition.
Can running continue with hallux rigidus?
Some people with hallux rigidus can continue running, but shoe choice and symptom response matter.
Running is more likely to be tolerated when:
- symptoms are mild;
- pain settles quickly after activity;
- the shoe has adequate stiffness or rocker;
- there is no significant swelling after runs;
- training load is progressed gradually;
- hills and sprints are limited during flare-ups; and
- the joint is not painful through the whole range of motion.
Running may need to be reduced or paused if the joint becomes swollen, progressively more painful or painful during ordinary walking.
Is hallux rigidus the same as a bunion?
No.
A bunion, or hallux valgus, usually involves the big toe drifting towards the second toe and a prominence forming on the inner side of the first metatarsophalangeal joint.
Hallux rigidus involves stiffness and arthritis of the big toe joint.
The two can coexist, but they are different problems. A bunion is primarily an alignment deformity. Hallux rigidus is primarily a degenerative stiffness and arthritis problem.
When is surgery considered?
Surgery may be considered when pain remains limiting despite appropriate conservative care.
Common surgical options include:
- cheilectomy;
- Moberg osteotomy;
- decompression osteotomy;
- interposition arthroplasty;
- synthetic cartilage implant;
- joint replacement; and
- first metatarsophalangeal joint fusion.
Cheilectomy may be useful when pain is mainly caused by dorsal impingement and there is still reasonable joint cartilage.
Fusion is often considered for advanced painful arthritis. Although fusion removes movement from the joint, it can provide reliable pain relief and a stable lever for walking when the joint is severely damaged.
The correct procedure depends on the stage of arthritis, patient goals, joint motion, sesamoid involvement, bone quality, footwear expectations and activity level.
Why early podiatric assessment matters
Early assessment is useful because hallux rigidus can be easier to manage before the joint becomes severely arthritic.
Early treatment may:
- reduce painful impingement;
- improve footwear tolerance;
- reduce compensatory gait changes;
- maintain activity;
- prevent unnecessary irritation;
- guide better exercise choices;
- reduce transfer pressure under the lesser toes; and
- clarify whether the problem is functional limitation, structural arthritis or another diagnosis.
From a podiatric perspective, the goal is to understand why this particular big toe joint is painful in this particular foot.
That requires more than simply saying, “You have arthritis.”
Key take-home message
Key take-home message
Hallux rigidus is a progressive arthritic condition of the big toe joint, but it is not always a simple wear-and-tear problem. It can involve inherited joint structure, previous injury, cartilage damage, first-ray mechanics, metatarsus primus elevatus, soft-tissue restriction, footwear irritation and altered gait.
A stiff big toe changes how the foot pushes off. Over time, this may affect the forefoot, arch, ankle and the way a person walks.
The first home step is often not aggressive stretching. It is usually a footwear reset: choose a wide, deep, stiff-soled or rocker-soled shoe that reduces painful bending of the big toe joint. Gentle mobility, short-foot activation and calf mobility may help selected patients when performed without provoking pain.
If symptoms persist, a podiatric assessment can identify whether the joint needs improved first-ray mechanics, offloading, orthotic support, shoe modification, imaging, injection therapy or referral for surgical opinion.
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Disclaimer: The word "treatment" in this article refers to the care and management of a patient’s health to prevent, cure, or improve a condition. Treatment results vary and do not necessarily indicate a cure. This article is for informational and educational purposes only and does not constitute medical advice.
About the author
Mark Reyneker is a podiatrist and human gait specialist with 8 years of training and over 25 years of clinical experience. He is the Founder and Clinical Director of Family Podiatry Centre and has a Bachelors degree in Podiatric Medicine and a Master’s degree in paleoanthropology, with research focused on human foot function and metatarsal loading.
Book An Appointment
Disclaimer: The word "treatment" in this article refers to the care and management of a patient’s health to prevent, cure, or improve a condition. Treatment results vary and do not necessarily indicate a cure. This article is for informational and educational purposes only and does not constitute medical advice.
About the author
Mark Reyneker is a podiatrist and human gait specialist with 8 years of training and over 25 years of clinical experience. He is the Founder and Clinical Director of Family Podiatry Centre and has a Bachelors degree in Podiatric Medicine and a Master’s degree in paleoanthropology, with research focused on human foot function and metatarsal loading.
References
- Anwander, H., Alkhatatba, M., Lerch, T., Schmaranzer, F. and Krause, F.G. (2022) ‘Evaluation of radiographic features including metatarsus primus elevatus in hallux rigidus’, Journal of Foot and Ankle Surgery, 61(4), pp. 831–835.
- Bergin, S.M., Munteanu, S.E., Zammit, G.V., Nikolopoulos, N. and Menz, H.B. (2012) ‘Impact of first metatarsophalangeal joint osteoarthritis on health-related quality of life’, Arthritis Care & Research, 64(11), pp. 1691–1698.
- Bouaicha, S., Ehrmann, C., Moor, B.K., Maquieira, G.J. and Espinosa, N. (2010) ‘Radiographic analysis of metatarsus primus elevatus and hallux rigidus’, Foot & Ankle International, 31(9), pp. 807–814.
- Canseco, K., Long, J., Marks, R., Khazzam, M.S. and Harris, G.F. (2008) ‘Quantitative characterization of gait kinematics in patients with hallux rigidus using the Milwaukee Foot Model’, Journal of Orthopaedic Research, 26(4), pp. 419–427.
- Colò, G., Fusini, F., Samaila, E.M., Mazzola, M.A., Pilone, G. and Magnan, B. (2020) ‘The efficacy of shoe modifications and foot orthoses in treating patients with hallux rigidus: a comprehensive review of literature’, Acta Biomedica, 91(4-S), pp. 57–63.
- Coughlin, M.J. and Shurnas, P.S. (2003a) ‘Hallux rigidus: demographics, etiology, and radiographic assessment’, Foot & Ankle International, 24(10), pp. 731–743.
- Coughlin, M.J. and Shurnas, P.S. (2003b) ‘Hallux rigidus: grading and long-term results of operative treatment’, Journal of Bone and Joint Surgery American Volume, 85(11), pp. 2072–2088.
- Dananberg, H.J. (1993) ‘Gait style as an etiology to chronic postural pain. Part I: Functional hallux limitus’, Journal of the American Podiatric Medical Association, 83(8), pp. 433–441.
- Durrant, M.N. and Siepert, K.K. (1993) ‘Role of soft tissue structures as an etiology of hallux limitus’, Journal of the American Podiatric Medical Association, 83(4), pp. 173–180.
- Grady, J.F., Axe, T.M., Zager, E.J. and Sheldon, L.A. (2002) ‘A retrospective analysis of 772 patients with hallux limitus’, Journal of the American Podiatric Medical Association, 92(2), pp. 102–108.
- Ho, B. and Baumhauer, J. (2017) ‘Hallux rigidus’, EFORT Open Reviews, 2(1), pp. 13–20.
- Horton, G.A., Park, Y.W. and Myerson, M.S. (1999) ‘Role of metatarsus primus elevatus in the pathogenesis of hallux rigidus’, Foot & Ankle International, 20(12), pp. 777–780.
- Lee, H.Y., Mansur, N.S., Lalevee, M., Maly, C., Iehl, C.J., Hembree, W.C., Godoy-Santos, A.L. and de Cesar Netto, C. (2023) ‘Does metatarsus primus elevatus really exist in hallux rigidus? A weightbearing CT case-control study’, Archives of Orthopaedic and Trauma Surgery, 143, pp. 755–761.
- Mahiquez, M.Y., Wilder, F.V. and Stephens, H.M. (2006) ‘Positive hindfoot valgus and osteoarthritis of the first metatarsophalangeal joint’, Foot & Ankle International, 27(12), pp. 1055–1059.
- Menz, H.B., Auhl, M., Tan, J.M., Levinger, P., Roddy, E. and Munteanu, S.E. (2016) ‘Predictors of response to prefabricated foot orthoses or rocker-sole footwear in individuals with first metatarsophalangeal joint osteoarthritis’, Journal of Foot and Ankle Research, 9, article 37.
- Munteanu, S.E., Zammit, G.V., Landorf, K.B., Scott, L.A. and Menz, H.B. (2021) ‘Shoe-stiffening inserts for first metatarsophalangeal joint osteoarthritis: a randomised trial’, Osteoarthritis and Cartilage, 29(4), pp. 480–490.
- Munteanu, S.E., Auhl, M., Tan, J.M., Landorf, K.B., Elzarka, A. and Menz, H.B. (2021) ‘Characterisation of first metatarsophalangeal joint osteoarthritis using magnetic resonance imaging’, Clinical Rheumatology, 40, pp. 5067–5076.
- Munuera, P.V., Domínguez, G. and Castillo, J.M. (2007) ‘Radiographic study of the size of the first metatarso-digital segment in feet with incipient hallux limitus’, Journal of the American Podiatric Medical Association, 97(6), pp. 460–468.
- Paterson, K.L., Hinman, R.S., Hunter, D.J., Wrigley, T.V., Menz, H.B. and Bennell, K.L. (2022) ‘Effect of foot orthoses vs sham insoles on first metatarsophalangeal joint osteoarthritis symptoms: a randomised clinical trial’, Osteoarthritis and Cartilage, 30(11), pp. 1511–1519.
- Pham, P., Dillard, S., Schilero, C. and Chiang, S. (2020) ‘Intraobserver and interobserver reliability of three classification systems for hallux rigidus’, Journal of the American Podiatric Medical Association, 110(3).
- Roddy, E., Thomas, M.J., Marshall, M., Rathod, T., Myers, H., Menz, H.B., Thomas, E. and Peat, G. (2015) ‘The population prevalence of symptomatic radiographic foot osteoarthritis in community-dwelling older adults’, Annals of the Rheumatic Diseases, 74(1), pp. 156–163.
- Roukis, T.S. (2005) ‘Metatarsus primus elevatus in hallux rigidus: fact or fiction?’, Journal of the American Podiatric Medical Association, 95(3), pp. 221–228.
- Roukis, T.S., Scherer, P.R. and Anderson, C.F. (1996) ‘Position of the first ray and motion of the first metatarsophalangeal joint’, Journal of the American Podiatric Medical Association, 86(11), pp. 538–546.
- Shurnas, P.S. (2009) ‘Hallux rigidus: etiology, biomechanics, and nonoperative treatment’, Foot and Ankle Clinics, 14(1), pp. 1–8.
- Stevens, J., de Bot, R.T.A.L., Hermus, J.P.S., Schotanus, M.G.M., Meijer, K. and Witlox, A.M. (2022) ‘Gait analysis of foot compensation in symptomatic hallux rigidus patients’, Foot and Ankle Surgery, 28(8), pp. 1272–1278.
- Van Gheluwe, B., Dananberg, H.J., Hagman, F. and Vanstaen, K. (2006) ‘Effects of hallux limitus on plantar foot pressure and foot kinematics during walking’, Journal of the American Podiatric Medical Association, 96(5), pp. 428–436.
- Vanore, J.V., Christensen, J.C., Kravitz, S.R., Schuberth, J.M., Thomas, J.L., Weil, L.S., Zlotoff, H.J., Mendicino, R.W. and Couture, S.D. (2003) ‘Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 2: Hallux rigidus’, Journal of Foot and Ankle Surgery, 42(3), pp. 124–136.
- Zammit, G.V., Menz, H.B., Munteanu, S.E. and Landorf, K.B. (2008) ‘Plantar pressure distribution in older people with osteoarthritis of the first metatarsophalangeal joint’, Journal of Orthopaedic Research, 26(12), pp. 1665–1669.
Frequently Asked Questions
The main symptom is pain and stiffness at the big toe joint, especially during push-off when walking. Many people also develop a bony bump on top of the joint that is often mistaken for a bunion.
Shoes with a stiff forefoot sole, mild rocker sole, wide toe box and deep upper are often helpful. Very flexible, narrow or shallow shoes may aggravate symptoms.
Gentle pain-free movement may help some people, but forceful stretching can aggravate an arthritic joint. If movement causes sharp pain, swelling or worsening symptoms, it should be stopped.
Yes, orthoses may help when they reduce painful big toe motion, improve first-ray mechanics or redistribute pressure. The orthotic design should match the stage and mechanics of the condition.
Running does not automatically cause hallux rigidus. However, running may aggravate symptoms in a mechanically vulnerable joint, especially with flexible shoes, hill running, sprinting or pre-existing cartilage damage.
Structural arthritis does not usually disappear, but symptoms can often be managed. Many people improve with shoe changes, orthoses, activity modification and podiatric care.
You should seek assessment if pain persists, the joint is swollen, shoes are difficult to wear, walking is affected, symptoms began after trauma, or the joint is red, hot or rapidly worsening.
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