The joint at the base of the big toe, also known as the metatarsophalangeal joint, can be the source of several painful problems. The most well-known of these is a bunion, which a bony enlargement along the inside of the foot that results from rotation and shifting of the first metatarsal over time.

Another issue that can befall this joint is hallux rigidus, sometimes referred to as a “dorsal bunion,” or more generally as a stiff big toe. In a case of hallux rigidus, the big toe joint slowly becomes more and more arthritic, stiff, and painful, and a bump may form on top of the joint (instead of along the inside, like a bunion).

If you notice that it is difficult to flex your big toe, please come see us right away. Like most foot and toe deformities, the best time to treat hallux rigidus is always during the earliest stages.

Hallux Rigidus

What Are the Symptoms of Hallux Rigidus?

In the earliest stages of hallux rigidus, the most noticeable symptom may be pain and soreness in the big toe joint, especially after periods of activity.

As the condition progresses, the toe becomes more and more stiff. You may notice swelling around the joint and an increase in the frequency and intensity of pain, occurring even after little-to-no physical activity.

Ultimately, you will notice a hard bump developing on the top of the joint at the base of the big toe. This is the result of bone spurs forming where the jamming or impingement of the joint occurs while walking. As the joint continues to wear down, the dorsal bump increases in size, making it more difficult to bend the toe or wear a shoe without pain.

Severe hallux limitus can even lead to limping, as well as pain in the legs, hips, and back, due to the way the inflexibility of the joint alters your gait mechanics.

Male person pulling big toe backwards isolated towards white

What Causes Hallux Rigidus?

The root cause of hallux rigidus is not always immediately obvious. However, some of the most common risk factors include:

  • Abnormalities in foot structure or gait. Some people are simply more prone to developing this condition due to the way they walk, or the way their feet are shaped. Faulty biomechanics causes impingement of the joint at the base of the big toe and accelerates the onset of arthritis.
  • Trauma to the joint. Hallux rigidus is more likely if you’ve previously jammed, stubbed, or otherwise injured your toe during activity. The condition could develop months or even years after the initial injury.
  • Environmental factors. Deterioration in the big toe joint may be accelerated by factors such as using poor footwear or participating in activities that require a lot of stooping or squatting.

How Is Hallux Rigidus Treated?

Our preference is to treat hallux rigidus non-surgically whenever we can. The chances of success are much greater if you seek our help in the early stage, before the joint becomes severely stiff or develops a dorsal bump.

Attempts to treat or manage hallux rigidus conservatively may include:

  • Wearing shoes with a larger toe box to avoid putting unnecessary pressure on the big toe. We might also recommend shoes with certain characteristics, such as stiff soles or rocker bottoms.
  • Using arch supports or orthotics to further reduce wear and tear by stabilizing the biomechanical problems causing the impingement and deterioration of the joint.
  • Making other lifestyle modifications to reduce wear and tear on the big toe joint—for example, losing weight or switching to a low-impact exercise plan.
  • Performing physical therapy exercises meant to reduce pain and improve strength and flexibility in the muscles, tendons, and ligaments that support and manipulate the toe.
  • Taking pain-relieving medications or an injection of cortisone.

If the toe has become extremely painful or stiff, and conservative treatments will not produce desired relief, surgery may be considered. Hallux rigidus surgery can range from simply removing bone spurs and debriding damaged portions of the joint to fusing the joint permanently or replacing it with an artificial joint. Each procedure has its own pros and cons, and we will help you determine which would be best for your circumstances depending on your age, activity level, personal goals, and other factors.

A stiff, painful big toe should never be underestimated. If you believe you may have hallux rigidus, please call us right away—even if the condition is in the early stages and not yet causing significant pain. We will do everything we can to ensure the best possible outcome with the smallest possible disruption to your day-to-day life. Call us at (252) 638-4700 or use the contact form below to connect with our team.