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Stiff Big Toe (Hallux Rigidus)

General Information:

The most common site of arthritis in the foot at the base of the big toe.  This joint is called the metatarsophalangeal, or MTP joint. It's important because it has to bend every time you take a step.  If the joint starts to stiffen, walking can become painful and difficult.  In the MTP joint, as in any joint, the ends of the bones are covered by a smooth articular cartilage.  If wear­ and ­tear or injury damage the articular cartilage, the raw bone ends can rub together.  A bone spur, or overgrowth, may develop on the top of the bone.  This overgrowth can prevent the toe from bending as much as it needs to when you walk. 

What are common symptoms?

  • Pain in the joint when you are active, especially as you push­off on the toes when you walk
  • Swelling around the joint
  • A bump, like a bunion or callus, that develops on the top of the foot
  • Stiffness in the great toe and an inability to bend it up or down

What is non-surgical treatment?

Pain relievers and anti­inflammatory medications such as ibuprofen may help reduce the swelling and ease the pain. Applying ice packs or taking contrast baths may also help reduce inflammation and control symptoms for a short period of time. But they aren't enough to stop the condition from progressing. Wearing a shoe with a large toe box will reduce the pressure on the toe, and you will probably have to give up wearing high heels. Your doctor may recommend that you get a stiff­soled shoe with a rocker or roller bottom design and possibly even a steel shank or metal brace in the sole. This type of shoe supports the foot when you walk and reduces the amount of bend in the big toe.

When is surgery recommended?

Surgery is usually recommended when damage is mild or moderate. It involves removing the bone spurs as well as a portion of the foot bone, so the toe has more room to bend. The incision is made on the top of the foot. The toe and the operative site may remain swollen for several months after the operation, and you will have to wear a wooden­soled sandal for at least two weeks after the surgery. But most patients do experience long­term relief.