Big toe arthritis (hallux rigidus)

Hallux rigidus is arthritis at the base of your big toe — the joint that has to bend backward every time you push off in walking or running. As the cartilage wears down, the joint gets painful, stiff, and gradually loses its upward bend. Bony spurs form on top of the joint and physically catch when the toe tries to extend, making each step feel like the toe is hitting a wall.

It's the most common arthritic condition of the foot. Most patients do well with simple changes to their footwear; only a minority eventually need surgery.

The first thing most people notice is pain at the top of the big toe joint when pushing off during walking or climbing stairs. The joint feels stiff — you lose the ability to bend the toe upward (called dorsiflexion), and forcing it provokes a sharp ache. A hard bony ridge (a dorsal osteophyte) forms on the top of the joint and can rub against the shoe, making the area red and swollen.

In earlier stages the pain is mostly with activity and settles with rest. As the arthritis advances the joint can ache even in flat shoes or at rest, and the toe becomes noticeably wider at the base. Some patients shift their weight to the outer edge of the foot to avoid bending the big toe, which can cause secondary pain in the ball of the foot (transfer metatarsalgia) or along the outside of the ankle.

Your surgeon will measure how far the big toe can bend upward (normal is at least 60°) and feel for the bony spur on top of the joint. A standing side-view X-ray shows the spurs, narrowed joint space, and flattening of the joint surface. The findings are graded on a 0–4 scale (the Coughlin-Shurnas grading) that helps decide which treatments to try.

1. NSAIDs

   NSAIDs like ibuprofen or naproxen for acute flares.

Surgery is offered for moderate-to-severe arthritis (grade 2–4) when non-operative care hasn't kept up and the toe is meaningfully limiting your activity. Options range from removing the bony spur (cheilectomy) for milder cases to fusing the joint (arthrodesis) for severe arthritis.

External patient-education references and related OSI pages for additional background:

• Britannica — Ankle (anatomy)
• AAOS OrthoInfo — patient education library
• OSI glossary — orthopedic terminology in plain language