What is it?
Cartilage in the first metatarsophalangeal (MTP) joint wears down, and bone spurs form on top of the joint that block motion. It is different from a bunion, although the two can coexist.
What causes it?
- Wear over time
- Prior injury such as turf toe
- Foot structure that stresses the joint
- Gout or inflammatory arthritis
What does it feel like?
- Pain and stiffness in the big toe, especially pushing off
- A bump on top of the joint that rubs in shoes
- Difficulty with inclines, squatting, or running
- Walking on the outside of the foot to avoid pain
How is it diagnosed?
An exam of joint motion and standing X-rays that grade the arthritis. The grade helps determine which treatments are likely to help.
When should you see a podiatrist?
- Stiffness and pain in the big toe lasting more than a few weeks
- A bump on top of the joint
- Pain limiting walking or exercise
Nonsurgical treatment
- Stiff-soled or rocker-bottom shoes
- Limit painful bending.
- Orthotics with a Morton's extension
- Restrict motion of the joint.
- Anti-inflammatory measures
- For flares.
- Injections
- Can relieve pain in selected cases.
When is surgery considered?
Surgery is considered when pain persists despite shoe and orthotic changes. The choice of procedure depends on how advanced the arthritis is.
Earlier disease may be treated with cheilectomy (removal of bone spurs). Advanced arthritis is most reliably treated with first MTP joint fusion.
Related procedures
What is recovery like?
Cheilectomy allows early walking in a surgical shoe. Fusion requires protected weight-bearing until the bones heal, typically six to eight weeks, followed by a gradual return to regular shoes.
Frequently asked questions
Can I still walk and exercise after a big toe fusion?
Yes. Most people walk normally and many return to activities such as hiking, cycling, and running. Very high heels become difficult.
Is hallux rigidus the same as a bunion?
No. A bunion is a problem of alignment; hallux rigidus is a problem of joint wear and motion.