Hallux rigidus is arthritis of the big toe joint, the most common arthritis in the foot. It causes pain and stiffness at push-off and a bony bump on top of the joint. Early on, footwear changes and injections help; advanced cases are treated with cheilectomy or a big toe fusion.
Symptoms
- Pain and stiffness on top of the joint at push-off, upstairs or uphill
- A visible bony spur on top of the joint
- Rolling onto the outer foot, causing secondary pain
- Pain at rest suggests advanced disease
Causes & risk factors
- A previous injury
- A long or raised first metatarsal
- High-loading sport or occupations
- Inflammatory arthritis
- A genetic component (about a third are bilateral)
Conservative treatment comes first
- A rocker-bottom sole with a wide, stiff toe box (the single most effective measure)
- A Morton's extension or carbon-fibre insole
- Activity modification
- An image-guided steroid or hyaluronic acid injection
When surgery is considered
A cheilectomy (grades 1–2) removes the dorsal spurs and restores 20–30° of movement — walking at 3–4 weeks, sport at 3 months, though arthritis can still progress. A first MTP fusion (grades 3–4) is a permanent end-stage solution that allows running and impact sport but ends joint movement and rules out high heels — sport at 4–6 months.
Questions & answers
Yes, usually from around 4 to 6 months. Many people return to impact sport.
It reliably relieves symptoms but does not stop the underlying arthritis, which can progress over time.
After fusion, flat and low-heeled shoes are fine; high heels are not possible.
Sources & further reading
- OrthoInfo (AAOS) — Hallux Rigidus
- BOFAS patient information
