Big Toe Osteoarthritis: Causes, Symptoms, and Treatment

Big toe osteoarthritis (hallux rigidus) is a condition where the joint at the base of the big toe (the first metatarsophalangeal or 1st MTP joint) wears out over time. This joint plays a key role in walking, running, and balance, so stiffness or pain here can have a big impact on daily life.

What Causes Big Toe Osteoarthritis?

• Osteoarthritis occurs when the protective cartilage covering the ends of the bones in a joint gradually wears down. In the big toe, this can happen due to:

  • Age-related wear and tear

  • Previous injury (stubbed toe, fractures, turf toe)

  • Repetitive stress from sports, dance, or certain occupations

  • Foot shape and biomechanics (e.g., flat feet, bunions)

  • Inflammatory conditions such as gout or rheumatoid arthritis

  When cartilage breaks down, the bones rub against each other, leading to pain, swelling, stiffness, and sometimes the formation of bony bumps (osteophytes).

Common Symptoms

• Pain in the big toe joint, especially during walking or pushing off the toes

• Stiffness and reduced upward movement of the toe

• Swelling or a hard bump on top of the joint

• Difficulty wearing certain shoes due to discomfort or deformity

• A grinding or catching sensation in the joint

Conservative (Non-Surgical) Management

Most cases can be managed without surgery—especially early on—by reducing stress on the joint and improving function.

1. Footwear Modifications

• Wear shoes with a wide toe box to reduce pressure.

• Use stiff-soled or rocker-bottom shoes to limit joint motion and pain.

2. Orthotics

• Custom or over-the-counter insoles can improve foot alignment and reduce strain.

• Carbon fibre inserts limit joint movement while walking.

3. Physiotherapy

A physiotherapist can help by:

• Joint mobilisation to maintain or improve range of motion.

• Stretching exercises for the toe and calf muscles.

• Strengthening exercises for foot and ankle stability.

• Gait retraining to improve walking mechanics and reduce stress on the big toe.

Example exercise:

• Toe extension stretch – Sit with your foot on your knee, gently pull your big toe upwards to stretch the joint (hold 15–20 seconds, repeat several times daily).

4. Pain Relief

• NSAIDs (e.g., ibuprofen) to reduce pain and inflammation.

• Topical anti-inflammatory gels applied directly to the joint.

5. Activity Modification

• Avoid activities that cause pain, such as running uphill or wearing high heels.

• Choose low-impact activities like cycling or swimming during flare-ups.

Minimally Invasive & Surgical Options

If pain persists despite conservative treatment, surgical options may be considered.

1. Corticosteroid Injections

• A steroid injection into the joint can reduce inflammation and provide pain relief for weeks to months.

• Often used when symptoms flare or before important events.

2. Surgical Procedures

a) Cheilectomy

• Removal of bone spurs and part of the joint surface to improve movement and reduce pain.

• Often used for mild-to-moderate arthritis.

b) Joint Fusion (Arthrodesis)

• The bones of the joint are fused together to eliminate pain.

• Very effective for pain relief but removes movement at the joint.

• Suited for advanced arthritis and active individuals who need a stable foot.

c) Joint Replacement (Arthroplasty)

• Damaged joint surfaces are replaced with an artificial implant.

• Aims to preserve some movement while reducing pain.

Recovery after surgery usually involves a period in a surgical shoe or boot, followed by physiotherapy to regain strength and walking confidence.

Prognosis and Long-Term Outlook

With early intervention—particularly through footwear adjustments, orthotics, and physiotherapy—many people can maintain good mobility and keep pain under control. For advanced cases, surgery can provide long-term relief and help restore activity levels.

Takeaway

Big toe osteoarthritis may sound small, but it can have a big effect on your mobility and quality of life. Whether through smart footwear choices, targeted exercises, or surgical solutions, there are effective ways to manage symptoms and keep you moving comfortably.

Physio In Motion can offer both physiotherapy and gait assessment using the latest footscan technology to help with foot and big toe pain. Along with this, orthotics can be made based of detailed individual footscan data to help if conventional exercises alone are not enough.