Your stiff, painful big toe joint might be arthritis (hallux rigidus)

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Arthritis is one of many diseases related to foot pain. Arthritis isn’t a single disease: it has many different kinds including rheumatoid arthritis, osteoarthritis and gout.

Arthritis pain in the feet usually presents first in the big toe joint, though it can affect any joint.

Hallux rigidus x-ray of right foot

Our podiatrists treat pain and stiffness in the big toe.

Causes include past injuries, family history or normal wear and tear

Pain and stiffness are the two main symptoms of degenerative arthritis in the joint where your big toe meets your foot (hallux means big toe and rigidus means stiffness). Undiagnosed and untreated, hallux rigidus will worsen over time.

Hallux rigidus is second only to bunions when it comes to causes of toe pain. Some people confuse hallux rigidus with a bunion (aka hallux valgus). You can even suffer from big toe arthritis and bunions at the same time (either one can cause the other).

Hallux limitus is often used interchangeably with hallux rigidus. Both terms describe restricted range of motion in the big toe joint, with rigidus being more severe. Hallux varus is another type of toe deformity that can be caused by arthritis in the big toe joint.

Diagnosing Hallux Rigidus

Hallux rigidus is arthritis in the great toe joint causing pain and stiffness at the base of your big toe. Swelling and inflammation can also be present. A podiatrist can diagnose hallux rigidus with a physical examination and, if needed, an X-ray to reveal joint degeneration and bone spurs.

Classifications of hallux rigidus:

  • Grade 0: Stiffness but no pain
  • Grade 1: Mild pain and stiffness, normal X-Ray
  • Grade 2: Moderate to severe pain and stiffness, X-Ray shows joint narrowing
  • Grade 3: Nearly constant pain and substantial stiffness at extreme range of motion, X-Ray shows significant joint narrowing
  • Grade 4: Same as grade 3 but pain is also present in mid-range of motion

Hallux rigidus usually develops in adults between 30 and 60 but can also occur in adolescence, and it affects more women than men.

Athletes with hallux rigidus

'Turf Toe' or sprain of the big toe joint can cause arthritis down the road.

Causes of Big Toe Arthritis

Wear and tear is considered the most common cause of pain and stiffness in the big toe joint. Arthritis caused by overuse is called osteoarthritis or ‘wear and tear arthritis.’

Athletes, people who work on their feet and people who often wear high heels run a bigger risk of injuries such as turf toe and pain in the big toe joint.

Hallux rigidus can also be caused by:

Arthritis of the big toe joint causes cartilage in the joint to wear down. When bones rub against each other your body grows more bone in an attempt to repair the damage, creating bone spurs. These can be further aggravated by ill-fitting shoes.

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Hallux Rigidus Symptoms

Most patients first notice a dull ache, followed by pain in the big toe joint when pushing off to start walking. Other common early symptoms include:

  • Reduced range of motion
  • Swelling and stiffness around joint
  • A painful bump on top of the big toe joint

As hallux rigidus progresses the function of your big toe changes. Eventually you may have difficulty walking and experience pain and stiffness in your knees, hips and lower back.

Untreated arthritis in the big toe joint can also lead to bunions forming from imbalanced walking.

Custom orthotics for hallux rigidus

The right orthotics can help relieve pain.

Hallux Rigidus Treatments

There are many conservative treatment options for hallux rigidus, and non-surgical treatment is always the first course of action.

Your podiatrist may suggest:

  • Pain relievers and/or anti-inflammatories
  • Ice or heat
  • Custom orthotics to limit joint extension
  • Wide shoes with a rocker bottom (curved sole)
  • Stretches and exercises
  • Steroid injections into the joint

Hallux rigidus is easier to treat when caught early. If you wait until bone spurs have formed, surgery may be required.

Surgical treatment options for hallux rigidus include:

Hallux rigidus surgery result

If surgery is required, we'll explain your options.

Chilectomy (cleaning up the arthritis) is surgery to remove the bone spurs and a bit of the foot bone so the toe can bend more easily. It’s usually recommended for mild to moderate damage.

After chilectomy patients must wear a rigid-soled sandal for two weeks and may experience welling for several months after. Many people have found long-term relief after this surgery.

Arthrodesis (fusion of the big toe joint) is usually recommended for severely damaged cartilage. Your surgical podiatrist will remove the cartilage and use pins, screws or a plate to keep the joint from moving. Eventually the bones fuse together.

After arthrodesis you will not be able to flex your big toe joint. Fusion of the joint is a reliable treatment for severe hallux rigidus pain.

Arthroplasty (joint implant) involves removing the big toe joint surfaces and replacing them with an artificial joint. Arthroplasty can relieve pain while keeping joint mobility.

Preventing Arthritis in the Big Toe Joint

There is no single method for preventing hallux rigidus. Keeping your feet and toes healthy will help prevent wear and tear, which is the leading cause of arthritis in the big toe.

Recommended steps for reducing your risk of hallux rigidus:

  • Get enough exercise to keep the joints in your toes and feet limber. Regular exercise also strengthens the muscles supporting joints.
  • Avoid repetitive motions and always rest if you feel pain. Injured joints are more likely to develop arthritis.
  • Maintain a healthy weight. Being overweight places extra stress on your joints, especially in your feet and knees.
  • Monitor your blood sugar. Type 2 diabetes doubles your risk of developing arthritis.

Milwaukee Podiatrists Treating Toe Joint Pain

If you have any pain in your big toe joint, don’t put off seeing a podiatrist. Early diagnosis and treatment gives you the best chance of fast relief and recovery. Advanced Foot and Ankle of Wisconsin has five podiatry clinics in the Milwaukee area. Our surgical podiatrists are experienced, compassionate and above all dedicated to improving the health of your feet.

Call or contact a podiatrist for big toe joint pain and schedule an appointment today.