top of page

Hallux Rigidus – A Stiff Painful Big Toe: Diagnosis & Treatment

Hallux rigidus is a condition in which the big toe joint (or the first metatarsophalangeal joint) becomes inflexible and painful. This may make it difficult for the individual to carry out day-to-day activities without experiencing pain or discomfort. In this article from ACTIVATE Clinic, we explain how we diagnose and treat this common foot problem.

How Can We Diagnose Hallux Rigidus?

Hallux rigidus is usually diagnosed based on the patient’s medical history, physical exam, and X-rays of the foot. A physical examination will help your doctor determine whether you have signs of Hallux Rigidus. Your doctor may also order further imaging tests such Ultrasound or MRI scans to rule out other conditions that might be causing your pain and stiffness.

Foot examination

Ultrasound for Hallux Rigidus

Ultrasound is a non-invasive test that can be used to evaluate the joints and soft tissues of your foot. The doctor will place an ultrasound probe on your toe to take pictures of the joint and surrounding tissue. Ultrasound can help assess whether there are any tears in your ligaments or tendons, which may be causing pain.

Foot and Ankle Ultrasound

What are the treatment options for Hallux Rigidus?

There are several treatment options for Hallux Rigidus. Treatment will depend on your symptoms, the severity of the condition and your overall health. Your doctor may recommend rest and avoiding activities that aggravate your symptoms for a period of time followed by physiotherapy. In most cases, this alone can relieve pain and stiffness in the big toe joint. You may also be advised to wear shoes with firm soles and heels that do not bend or flex when you walk. If the above treatments do not provide adequate relief, injections or surgery would be indicated.

Foot and ankle physiotherapy

Physiotherapy for Hallux Rigidus

Physiotherapy can help you to manage the symptoms of Hallux Rigidus (pain or stiffness) you may be experiencing. This includes a combination of exercises and stretches supervised by a physiotherapist or by following a digital physiotherapy prescription.

Foot and ankle stretching

What orthotics are there for Hallux Rigidus?

Orthotics are devices that can be placed inside your shoe to help relieve the symptoms of Hallux Rigidus. Orthotics are usually recommended if you have mild or moderate pain or stiffness in your big toe joint. They may also be recommended if you have arthritis in other joints of your foot, such as the joints around the tarsal and metatarsal bones, which can cause pain when walking. Orthotics are specially designed or custom-made inserts that fit into your shoes and help cushion and support your feet, so they are better able to bear weight on uneven surfaces.

Foot Orthotics

What injections are available for Hallux Rigidus?

There are several injections that can be used to treat Hallux Rigidus. These include Corticosteroid and Hyaluronic acid injections. Corticosteroid Injections may be recommended for people with mild to moderate hallux rigidus pain that is not relieved by other treatments, such as shoe inserts or physical therapy. The medications help reduce inflammation in your big toe joint so it can move more easily.


Hyaluronic Acid Injection for Hallux Rigidus

Hyaluronic acid is a naturally occurring substance in your body that helps lubricate joints and keep them healthy. It is made from molecules of sugar and protein, which are broken down into smaller molecules by your body.

Hyaluronic acid injections are another option for treating Hallux Rigidus. The injection contains a gel that hydrates your joint and can help ease pain. You may need to have multiple treatments over time, but they may be less expensive than other procedures. An ultrasound scan is sometimes required to localise the joint and provide accuracy in guiding the injection into the joint space.

Ostenil mini injection for small joints
OSTENIL mini TRB Chemedica

Surgery for Hallux Rigidus

If all non-surgical treatments have been exhausted, surgery may be recommended. Surgery for Hallux Rigidus can involve removing part of the first metatarsal head (Cheilectomy), which can relieve the pressure and improve range of movement. Alternatively, surgery may be performed to remove part of the first metatarsal head, reshape it and inserting a spacer so there is more room for your first metatarsal head to move around. A more invasive procedure may be recommended where both ends of the joint are removed and the joint is fused.

If you are experiencing symptoms of Hallux Rigidus or any other foot problem, contact us or book an appointment online to get a diagnosis and start treatment. ACTIVATE Provides a comprehensive range of non-surgical treatments for foot conditions.

Foot and ankle anatomy

About the Author: Dr. Mustafa Alnaib MBChB, MRCS, MSc, FEBOT is an orthopaedic surgeon, musculoskeletal doctor and Clinic Director at ACTIVATE Musculoskeletal Clinic in Kent.


bottom of page