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HALLUX RIGIDUS

When the big toe stiffens

Hallux rigidus is a progressive degenerative condition of the first metatarsophalangeal joint, the joint at the base of the big toe. Unlike hallux valgus, where the toe deviates sideways, the leading feature here is restricted movement of the big toe. The joint increasingly loses its ability to glide, which can lead to pain, inflammation and ultimately to stiffening.

How does hallux rigidus develop?

The precise causes are varied – usually it is a combination of mechanical loading, unfavourable foot mechanics and genetic predisposition:

  • Genetic predisposition (running in the family)
  • Chronic overloading (through sport or physically demanding work, for example)
  • Injuries or contusions around the big toe joint
  • Foot deformities such as flat foot or high-arched foot
  • Rheumatic or metabolic disorders (gout, for example)
  • Osteoarthritis developing after a previous hallux valgus or after surgery

Symptoms

The symptoms usually develop gradually and are often underestimated at first. The main features are pain when rolling the foot off the ground and increasing stiffness in the big toe joint, which can noticeably affect walking and everyday life.

Pain

Pain in the first metatarsophalangeal joint, particularly when rolling the foot off the ground or when walking for longer periods

Stiffness of the big toe

The big toe can only be moved to a limited extent, above all when lifting it upwards (dorsal extension).

First-step pain

After periods of rest, or in the morning, the big toe joint is distinctly painful, but often improves as you move about.

Treatment options for hallux rigidus

Treatment of hallux rigidus depends on the stage of the condition, the mobility of the joint, the level of pain and the demands of your everyday life and sport. The aim is to relieve pain, preserve walking function and prevent the condition from getting worse.

Treatment options

Non-surgical and surgical – we will find the right approach for you

Non-surgical

Orthopaedic shoes or insoles

Stiff soles or special rocker-bottom adaptations take load off the joint and reduce pain when walking.

Non-surgical

Physiotherapy

Maintaining mobility, mobilisation and strengthening of the surrounding muscles. The aim is to support the function of the joint and to avoid compensatory movement patterns.

Non-surgical

Medication

Painkillers and anti-inflammatory drugs such as ibuprofen or diclofenac can help with acute symptoms.

Non-surgical

Low-dose radiotherapy

Low-dose radiotherapy is a low-dose, anti-inflammatory form of radiation treatment that can be used to relieve pain in hallux rigidus (osteoarthritis of the first metatarsophalangeal joint).

 Surgical

Cheilectomy – removing bone spurs

This operation preserves the joint and is mainly an option in the early to intermediate stages of osteoarthritis, when the joint still has a certain amount of movement.

 Surgical

Arthrodesis – fusing the big toe joint

If the joint is badly damaged and there is barely any movement left, or movement is only possible with pain, arthrodesis is the most reliable surgical solution.

Frequently asked questions about hallux rigidus

What is the difference between hallux valgus and hallux rigidus?
With hallux valgus the leading feature is the sideways deviation of the big toe; with hallux rigidus it is stiffening of the first metatarsophalangeal joint caused by osteoarthritis. Both conditions affect the same joint, but they have different causes and symptoms.
Do I always need surgery for hallux rigidus?
Not necessarily. In the early stages, non-surgical measures such as special shoes, insoles or physiotherapy often help. Surgery is only considered once the pain increases or everyday life is severely restricted.
Why is rolling the foot off the ground so painful?
When walking, the big toe has to move upwards (dorsal extension). It is precisely this movement that is restricted and painful in hallux rigidus, because the cartilage in the joint is worn and bone spurs can block the movement.
Will I still be able to walk normally after a fusion?
Yes. Arthrodesis does stiffen the first metatarsophalangeal joint, but the healthy neighbouring joints allow an almost normal gait. Many patients report pain-free, stable weight-bearing after the operation – including during sport.

Our foot specialists

Experienced consultants for hallux rigidus and foot surgery

Dr. med. Friedrich Quarck

Dr. med. Friedrich Quarck

Consultant in Orthopaedics and Trauma Surgery