Hallux Rigidus is a common cause of stiffness, pain, and inflammation of the joint at the base of the big toe. Here we explain the symptoms, causes, and treatment.
Medically reviewed by Dr Chaminda Goonetilleke, 20th Jan. 2022
Hallux rigidus symptoms
Initial symptoms include:
- Pain and stiffness at the base of the big toe (called the MTP joint)
- Pain is worse when walking.
- Your big toe may appear swollen and inflamed.
- As it gets worse, you may also experience loss of movement in the joint, or walk with a limp.
- Eventually, you will feel pain in the toe continuously.
- The top of the MTP joint will be tender to touch.
- You may notice a lump over the joint, where new bone growth has occurred.
- X-rays may require to identify degeneration in the joint, or excess bone growth.
Eventually, lower back, hip, or knee injuries may result due to changes in the way you walk.
What is Hallux rigidus?
The Hallux is the Latin word for the big toe and rigidus literally means rigid or stiff. The big toe is important in walking and running as it dorsiflexes (bends back) as you run or walk.
In Hallux Rigidus, the movement in the joint at the base of the big toe gradually decreases. Initially, the term Hallux Limitus is often used and the term rigidus is used later as the movement becomes considerably reduced. It is a form of degenerative arthritis although is often initially confused with a bunion.
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The condition can cause lots of further problems, especially with walking, as we require at least 60 degrees of dorsiflexion at the MTP joint for a normal walking pattern. If this is not available, compensations are made elsewhere, for example, in the ankle, knee, and pelvis.
What causes a stiff big toe?
It can be caused by either a traumatic injury or overuse.
Overpronation or where the foot rolls inwards too much increases the stress on the joint. As a result, over time, repetitive weight-bearing in a dorsiflexed position makes it more likely to occur.
Activities such as when walking up mountains or driving forward in a rugby scrum require large forces to be transmitted through the MTP joint in a dorsiflexed (bent upwards) position.
Traumatic injury such as stubbing your big toe causes damage to the cartilage within the joint.
A hypermobile 1st metatarsal bone is one which has too much movement. Over time this can also cause your big toe to stiffen.
Rheumatoid arthritis, which is inflammatory wear and tear of the joint.
Gout is a form of arthritis caused by excessive uric acid in the joint, and can also cause Hallux rigidus.
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Treatment for stiff big toe
Treatment of hallux rigidus is usually conservative, which means without surgery.
Avoiding painful activities such as walking, running and jumping. Instead, substitute swimming or cycling if possible until symptoms settle down. This should allow pain and inflammation to reduce and normal movement to return.
A doctor may prescribe anti-inflammatory medications such as Ibuprofen. Always check with a doctor before taking medications as some, such as Ibuprofen should not be taken by asthmatics.
A doctor may also prescribe a corticosteroid injection.
Any contributing biomechanical factors such as overpronation should be corrected. Physical therapy may be used to try to increase the range of motion at the joint.
In extreme cases, surgery may be required to remove bony growth on top of the joint, or even a total arthroplasty (joint replacement) can be done.