Hallux Rigidus

Bone and Joint Conditions· Also known as: stiff big toe, arthritis of the big toe joint, first MTP joint osteoarthritisUpdated Oct 2026

Reviewed by Andrew Schox, BSc(Hons) PGradDipPod MPod, October 2026

At a Glance

Hallux rigidus is arthritis of the main joint of your big toe. The joint surfaces wear, which causes pain, swelling, stiffness and less movement. It is described as the most common arthritis of the foot, and about 2.5 per cent of people over 50 report it. The main symptom is pain and stiffness when the toe bends up, such as on stairs or when walking or running. About half of people do well with non-surgical care such as better shoes, insoles and pacing activity. Surgery is an option if those don't help.

What is it?

Hallux rigidus is arthritis of the main joint of your big toe, where it meets the long bone of your foot (the first metatarsophalangeal, or MTP, joint). The smooth surfaces inside the joint wear out. This causes pain, swelling, stiffness and less movement.

A slight loss of movement is called hallux limitus. Hallux rigidus is a bigger loss, and sometimes the toe can't move at all. They are on one spectrum, and the condition tends to build up gradually over time.

It is sometimes confused with a bunion. In hallux rigidus the bony lump is on top of the toe joint. In a bunion the bump is on the inner side of the toe. Only a practitioner can tell them apart, so have it assessed rather than guessing.

Who does it affect?

Hallux rigidus is common and can be painful. About 2.5 per cent of people over 50 report it. Often both feet are affected: up to 79 per cent of people have it in both.

Family history seems to matter. Almost two-thirds of people with it have a relative with the same problem. It isn't yet clear how it differs between men and women, or how it affects children.

Signs and symptoms

The typical signs are pain and stiffness in the big toe joint. It is usually worse with things that bend the toe up, such as stairs, running or push-ups. Some people feel pain only when the toe is bent up as far as it will go. Others feel it with every step, or even at rest.

The toe usually can't bend upwards as far as it should, though it can often still bend downwards. A bony lump or swelling often forms on top of the joint. It can rub on your shoes and hurt.

Some people notice numbness or tingling if the lump presses on a nerve. If you walk on the outer side of your foot to protect the toe, you may also get pain in the ball of your foot or along its outer edge.

What causes it?

Often there is no clear cause. As in other joints, the cartilage (the smooth cushioning layer) slowly thins and wears. The big toe joint takes a lot of load: with each step, a force equal to twice your body weight passes through it.

Things that may add to the risk include:

a past injury, such as stubbing, spraining or breaking the toe
repeated heavy loading, such as deep squatting
the shape of the bones in your foot
inflammatory conditions such as gout or rheumatoid arthritis
shoes that don't fit well or give little support
a family history

These are linked to the condition, but none is a proven cause. Don't assume that a past injury or your foot shape is to blame.

How is it diagnosed?

Your podiatrist will ask when the pain started, any past injury, what makes it worse and how it has changed. They will check how well the toe moves, where it is tender, whether you have any numbness and how strong the muscles are. They may press and turn the joint to see if that brings on pain. They will also look at your shoes and how you walk.

An X-ray is usually needed to confirm it. If an inflammatory condition is suspected, you may have blood tests as well. The assessment also checks for other causes of toe pain, including a fracture, gout, rheumatoid arthritis, infection, a problem with the small bones under the big toe joint (the sesamoids), and pain in the ball of the foot from other causes. Treating the wrong problem can mean long-lasting pain and loss of function, so a proper assessment is worthwhile.

Treatment

Care usually starts without surgery. Most advice comes from expert guidance, and the evidence for non-surgical treatments overall is limited. About half of people do well with these measures.

Looking after it at home

Choose shoes with a deep, wide toe box and a firm, stiff sole that doesn't bend. A low heel is better than a high one. Avoid thin, flexible soles. A rocker sole (a sole curved front to back) may reduce movement at the joint and so reduce pain. Bunion gel covers can cushion the lump if it rubs.

Pace your activities and avoid those that force the big toe far upwards if they bring on pain. If you are carrying extra weight, losing some can help take load off the joint. A pharmacist or your GP can advise on pain relief, including an anti-inflammatory gel for the toe. Check whether anti-inflammatory medicines suit you before using them.

Treatment from your podiatrist

Your podiatrist can explain the condition, advise on footwear and activity, and prescribe exercises where they suit you. They may also suggest insoles or orthoses (shoe inserts made to support the foot) that reduce movement at the joint. Guidance describes these as useful, and some people find they help.

Insoles that curve to support the arch, and inserts that stiffen the shoe, probably make little or no difference to pain, function or quality of life. Ask your podiatrist what they expect an insole to do for you.

Other options

If simple measures aren't enough, a steroid injection into the joint may be considered. A single injection of hyaluronic acid (a gel-like substance used in joints) probably makes little or no difference to pain or function.

Surgery

Your GP or podiatrist may refer you to a surgeon if footwear, insoles and activity changes haven't helped, if the diagnosis is unclear, or if symptoms are getting worse. Severe symptoms, or no response to podiatry or injections, are also reasons to be referred.

Two main operations are used. Cheilectomy removes the bony lumps from the joint, and is used for early to moderate wear. Fusion (arthrodesis) joins the bones of the joint so they heal together. It is advised for severe wear, or where less than half of the cartilage remains at the time of surgery. If surgery is offered, ask which operation is proposed and why. Also ask about the risks, recovery time and what to do if problems arise.

Bring weight-bearing X-rays (taken while you stand) for the specialist. After surgery, keep the foot clean and dry until the stitches are out. Tell your surgical team about severe pain, massive swelling, or excessive numbness or pins and needles.

Recovery

Hallux rigidus is a gradual condition, and the joint tends to move less over time. How often it gets worse without treatment isn't clear yet. For that reason, don't wait out worsening symptoms: ask for a review if your toe gets worse or stops responding to your usual measures.

Many people manage well by keeping up supportive, stiff or rocker-sole shoes, any insoles they have been advised to use, and pacing their activity. If these don't help, surgery is an option.

When to see a podiatrist

Book an appointment if

Your big toe pain has lasted more than 2 weeks despite home care, it is stopping you from doing your usual activities, or footwear, insoles and pacing aren't helping or the toe is getting worse. Also book if you aren't sure what is causing the pain. If you have diabetes and any foot pain, see your podiatrist or GP soon, because foot problems can be more serious.

Seek prompt assessment if

you have just injured your toe and think it may be broken, or it looks bent or out of line: see your GP or another doctor today, and don't treat a possible broken toe yourself. See your GP or another doctor today too if your toe is hot, red or swollen, or if you have diabetes and a new sore or spreading redness on your foot. If your GP can't see you today, go to an urgent care clinic or an after-hours GP. If you have a toe infection or open sore and also feel very unwell, with confusion or slurred speech, severe shivering or muscle pain, severe breathlessness, mottled or discoloured skin, or little or no urine, this could be sepsis: call your local emergency number. See your GP as soon as you can if you have an open sore on your toe that isn't healing, even with care from your podiatrist, as you may need an urgent referral to a bone and joint surgeon. If you have had surgery, tell your surgical team or see a doctor today if pain is getting worse and doesn't settle when you raise your foot and take mild painkillers (it can be an early sign of infection), or if swelling of your leg or foot doesn't settle when raised above heart level.

Frequently asked questions

Can I keep running or exercising?

You may be able to, with changes. Activities that bend the big toe far upwards, such as running and stairs, tend to bring on pain, so cut back on these if they flare it. Your podiatrist can help you pace your activity and suggest what suits you.

Does ice help?

Some people find it eases pain. Wrap ice in a damp cloth and use it for 10 to 20 minutes at a time. Don't ice a numb area or an open wound, because of the risk of burns and infection. Stop if your pain, swelling or skin soreness gets worse.

What should I bring to my appointment?

Bring the shoes you wear most, so your practitioner can look at them. It also helps to note when the pain started, any past injury, what makes it worse (stairs, running or certain shoes) and how it has changed. Mention any family history of big toe problems.