Hallux Rigidus: What It Is and How to Treat It, According to Physical Therapists

Your big toe may be small, but it plays a surprisingly major role in helping you stay mobile. Without it, it would be much harder to walk, run, rise up on the balls of your feet, or simply stand without toppling over. So when your big toe is feeling a little sore, it can make life more challenging and uncomfortable.

One common reason why your big toe may be sore is a condition called hallux rigidus, which is essentially a fancy name for arthritis of the big toe, says Mary Kimbrough, PT, DPT, physical therapist at Hinge Health. Like most forms of arthritis, hallux rigidus can usually be treated at home with conservative measures, like exercise therapy, and tweaks to your lifestyle and footwear. 

Read on to learn more about hallux rigidus — what it is, what causes it, and what you can do about it, including exercises recommended by Hinge Health physical therapists. 

What Is Hallux Rigidus?

“Hallux rigidus refers to arthritis that occurs when the joint at the base of your big toe stiffens,” explains Dr. Kimbrough. In fact, it’s the most common type of foot arthritis.

To get a better understanding of hallux rigidus, it helps to have a quick primer on foot anatomy. One of the joints in your big toe is the metatarsophalangeal joint (MTP). This is where the metatarsal bone of your foot meets the bone of your big toe. You use this joint to bend your big toe, grip the ground, and walk. When you have hallux rigidus, the cartilage at the end of one or both of these bones changes, leading to stiffness and pain. 

Sometimes you can also develop bone spurs at the base of your big toe, which can prevent your big toe from bending and make it harder to walk.

Symptoms of Hallux Rigidus

Hallux rigidus can feel different to everyone, but here are a few common symptoms you may notice if you start to develop hallux rigidus:

• Pain in your big toe joint. “People with hallux rigidus will often have some pain when they walk or stand. You’ll usually feel the pain on the top of the joint, but you may also feel it deep inside the joint, too. “This is because when you stand, most of your weight bearing goes through your big toe,” says Dr. Kimbrough. “When you walk, you also use the big toe to push off with each step.” You may notice that the pain worsens when you lunge down, say, to pick up something from the floor, or walk up an incline. Anything that involves putting weight on your big toe can cause some pain or discomfort if you have hallux rigidus, says Dr. Kimbrough. 

• Swelling around your big toe joint. A common arthritis symptom is swelling (due to increased fluid in the joints) and the big toe is no exception. If your arthritis symptoms are flaring up, you may notice more swelling around your big toe joint, which can make it harder to wear certain shoes comfortably.

• A bump like a bunion or callus that develops on the top of your toe joint. This may also be caused by swelling and irritation. “You may see redness in that area, too,” notes Dr. Kimbrough.

• Stiffness in the big toe. Stiffness is another common arthritis symptom that can result from cartilage changes. You may find it harder to bend your big toe.

What Causes Hallux Rigidus?

Hallux rigidus sounds scarier than it is. In fact, it’s often a normal part of aging. “It’s normal for our joints to experience changes as we get older,” says Dr. Kimbrough. But there are some things that can make you more likely to experience it, she adds. These include:

• A past injury to your big toe. This can cause changes to cartilage that contribute to symptoms of hallux rigidus.

• Foot anatomy. If you have flat feet, there can be more stress on your MTP joint, making you more likely to develop arthritis. The same is true if your ankles pronate, or roll in.

• Your job. If you have to stoop or squat a lot as part of your work, you may be putting more stress on your big toe.

• Inflammatory arthritis. People who have conditions such as rheumatoid arthritis or gout are more susceptible to hallux rigidus.

While you can’t control all of these possible causes or risk factors, not everyone who has them develops hallux rigidus. And even if you do, there’s still a lot within your control when it comes to managing the symptoms and getting back to the activities you enjoy.

Treatment Options for Hallux Rigidus

Most people who are impacted by hallux rigidus pain can manage their pain at home, says Dr. Kimbrough. Treatment options for hallux rigidus include:

Physical therapy. Physical therapy can help treat hallux rigidus since it improves surrounding muscles and range of motion in the joint, says Dr. Kimbrough. A physical therapist (PT) can work with you to develop a specific program designed to increase toe joint mobility, strengthen the surrounding muscles, and improve your overall functioning. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit. 

Exercise. It’s important to stay active to help keep your toe joint limber and promote blood flow to the area, says Dr. Kimbrough. The key is to choose movement that your body is prepared for. “You may find certain activities, such as hiking or walking uphill, more challenging initially with this condition,” points out Dr. Kimbrough. If you can tolerate these, or other, high-impact activities like running, that’s great. If not, you can try scaling back until you’ve had a chance to stretch and strengthen the area. Scroll down for some specific exercises to try.

Footwear changes. There’s no such thing as the “perfect” shoe that’s right for everyone. But, in general, people with hallux rigidus may feel better if they avoid high heels or shoes that are too tight, which will put more pressure on your toes. “Most people do well with a shoe that has a wide toe box, so it doesn’t squeeze the joint,” says Dr. Kimbrough. Ideally, it also has a rocker bottom: “This means the shoe has a U-shape on the bottom that helps you push off when you walk,” she explains. If you still need more support, Dr. Kimbrough recommends that her patients get a carbon fiber (or other stiff material) insert, which you place into the sole of your shoe. “It can help support your foot as you walk and reduce the amount of bend in your big toe,” Dr. Kimbrough says.

Heat or ice. Either can help provide relief, but many people tend to prefer heat for a chronic condition like arthritis, because it increases blood flow and opens up blood vessels at the affected joint, says Dr. Kimbrough.

Over-the-counter (OTC) medication. Nonsteroidal anti-inflammatory medications (NSAIDs) such as naproxen (Aleve), ibuprofen (Advil, Motrin), and aspirin can be helpful for treating occasional pain flare-ups from hallux rigidus. Topical anti-inflammatories can also be helpful. It’s important to make sure that you’re safely able to take these medications, based on your medical history. 

Most people with hallux rigidus respond very well to exercise and can use it to increase their mobility and decrease their pain over time. These exercises, recommended by Hinge Health physical therapists, are a great place to start.

The information contained in these videos is intended to be used for educational purposes only and does not constitute medical advice or treatment for any specific condition. Hinge Health is not your healthcare provider and is not responsible for any injury sustained or exacerbated by your use of or participation in these exercises. Please consult with your healthcare provider with any questions you may have about your medical condition or treatment.

PT Tip: Don’t Rush Into Shots or Surgery 

Most of the time, steroid injections or foot surgery aren’t necessary to relieve hallux rigidus symptoms, says Dr. Kimbrough. “Usually, people have a good enough response to conservative therapies like physical therapy, that they’re able to resume their regular activities,” she explains.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you. 

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. 

Additionally, you’ll have a personal care team to guide, support, and tailor our program to you. See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

1. Ho, B., & Baumhauer, J. (2017). Hallux rigidus. EFORT Open Reviews, 2(1), 13–20. doi:10.1302/2058-5241.2.160031

2. Lam, A., Chan, J. J., Surace, M. F., & Vulcano, E. (2017). Hallux rigidus: How do I approach it? World Journal of Orthopedics, 8(5), 364. doi:L10.5312/wjo.v8.i5.364

3. Chan, O., & Sakellariou, A. (2020). Hallux rigidus: a review. Orthopaedics and Trauma, 34(1), 23–29. doi:10.1016/j.mporth.2019.11.004

4. Fields, K. B. & Atkinson, B. (2023, November 1). Evaluation, Diagnosis, and Select Management of Common Causes of Forefoot Pain in Adults. UpToDate. Retrieved from https://www.uptodate.com/contents/evaluation-diagnosis-and-select-management-of-common-causes-of-forefoot-pain-in-adults