Hallux rigidus, is arthritis (pain and stiffening) of the main joint of the big toe in the ball of the foot. It is due to a wearing out of the joint surfaces. Sometimes only the upper part of the joint is affected and the rest of the joint is undamaged. In other people the whole joint is worn out.

What are the causes of this condition?

The main joint of the big toe is under significant stress when walking and this may be why, in some cases, it is prone to osteoarthritic changes. With each step, a force equal to twice your body weight passes through it. Hallux rigidus can also be caused by a previous injury or another medical problem such as gout.

What are the symptoms?

Pain in the big toe joint

Pain in the big toe joint. This can be present for some people, whenever they walk or even at rest, but in others it only occurs when they turn the big toe up as far as it will go.

Stiffness

Stiffness, the ability to turn the big toe upwards is lost, although it can usually be turned downwards. Sometimes it gets so stiff it points downwards and cannot be laid flat on the floor.

A bony bump

A bony bump (“osteophyte” or “dorsal bunion”) may develop on top of the joint. The bump may rub on the shoes.

Pain

Because of the painful big toe some people tend to walk on the side of the foot. This may produce pain in the ball of the foot or down its outside border.

Bunion type deformity

Sometimes the big toe moves and rubs on the adjacent toes (forming a bunion type deformity) towards the second toe, and the toes may rub together.

How is a diagnosis made?

A diagnosis is normally made on your symptoms, clinical examination and X-rays.

What treatments are available for this condition?

In the first instance simple treatment measures can be used to try and reduce your symptoms. These may include:

Appropriate footwear / footwear adaptations

A shoe with a deeper toe box and stiffer sole may help reduce rubbing and restrict movement through the joint.

Orthoses

Orthoses (medical insoles) can be useful in improving foot function and reducing pain.

Painkillers

Painkillers such as paracetamol may help reduce your symptoms

Weight-loss and lifestyle

If you are overweight, then losing weight can help. This will reduce the stresses going through the foot. There are some excellent resources for losing weight here and advice on the best diet for those with arthritis.

Other treatments

Injection (steroid) therapy

Injection (steroid) therapy into the joint - this can help reduce pain and inflammation

Surgery

This may be carried out if other treatments fail. This often means stiffening (fusing) the big toe joint. You will then have screws or a plate in the foot.