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Hallux Rigidus

This is the proper name for arthritis in your big toe joint. It can either be a clinical diagnosis (based on observations and your experience of the symptoms) or a radiological diagnosis (based purely on the findings of an X-ray; with no symptoms whatsoever).

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A foot x-ray that shows narrowing of the first metatarsophalangeal joint as well as a mild valgus deformity.

About Hallux Rigidus

Hallux Rigidus is arthritis in the big toe joint. Depending on who you see, this will mean that you either have 

  • Reduced movement in the joint, or

  • No movement in the joint

Some clinicians will refer to the reduced movement version as 'Hallux Limitus'. 

This can be the result of significant damage done to the joint (even decades earlier), or it can be the result of lots of small amounts of damage done to the joint - perhaps through the way your foot functions etc.

Grading Hallux Rigidus

Medicine and healthcare like to give 'grades' to everything, and there are lots of different ways of measuring the severity of Hallux Rigidus. In both the clinical and radiographic settings, the grades tend to have four levels, summarised as:

Clinically:

  1. Healthy joint, no restrictions

  2. Mostly healthy joint, but restricted at end of range

  3. Still a bit of movement, but not enough to be happy

  4. No movement.

Radiographically:

  1. Healthy joint, lots of space

  2. Space slightly reduced, bumpy bits around joint

  3. Space is significantly reduced, bumpy bits present.

  4. No space between the bones - joint is fused.

It's important to remember that the grading systems don't  mention anything about pain or function; so just because you scored highly, it doesn't mean you can't do things.

A sitting person trying to dorsiflex their big toe upwards - an action that those with hallux rigidus cannot do.
A graphic image of the bottom of a foot showing the complexity of the anatomy.

What else could it be?

Hallux Rigidus is an arthritic condition which restricts movement in the big toe joint and there aren't really many conditions that also do that, save Hallux Limitus. However, there are conditions that can co-exist or be precursors to Hallux Rigidus:

How is Hallux Rigidus diagnosed?

Clinical examination and the history you give is often adequate: ultimately, your big toe hurts when you bend it! However, imaging might be used to

  • Confirm the diagnosis

  • Identify how severe the problem is

  • Rule out other problems.

  • Give consideration to types of surgery that might be helpful

Imaging that can be used for FHL issues is:

  • X-rays are used for grading and give a good overview of the joint's integrity

  • Ultrasound scans can be useful for confirming osteophyte presence

  • MRIs may be useful if the cartilage is damaged and causing catching.

A sagittal view of a foot MRI that might be used to identify cartilage damage within an arthritic joint.
A barefoot person stands with their big toes pointing skywards.

How is Hallux Rigidus treated?

Treatments can take a variety of formats, each with different goals:

  1. Pain reduction

  2. Improving range of motion

  3. Restricting range of motion

The reason most people come for an appointment is because they are in pain when they do stuff, so depending on their goals, the treatment will vary. Treatments can take a variety of forms including:

  • Education & understanding the condition

  • Painkillers - including when and how to use them

  • Footwear advice

  • Insoles and orthotics

  • Taping, strapping and padding

  • Injections:

    • Steroids​

    • Hyaluronic acid​​

  • Surgery​​​

Ready to start being pain free?

How long does it take to cure Hallux Rigidus?

Hallux Rigidus is a form of osteoarthritis, so unfortunately it is a progressive condition. However, treatment can be aimed at slowing down the progression of pain and dramatically improving your quality of life. 

Generally speaking, patients can expect to have symptoms improved significantly within 3 weeks of starting treatments.

This comes with the caveat that, for some patients, certain treatments will not be appropriate at some points in the condition's stage; so a dynamic approach might be required if you are coming in when your symptoms are severe. 

Lady running with her dog
Ready to say goodbye to your pain?

At Keep On Your Feet, we openly acknowledge that we cannot guarantee a cure for things: but we will work as hard as we can with you to help you reach your goals. 

If your symptoms fit the above, you will need to book a 'Foot Pain' consultation. This will be £95 and lasts approximately 60 minutes usually. If you need insoles, we'll give you some basic ones to try out (or some fancier ones and reduce their price!). 

This is a picture of Jeremy Ousey, director and podiatrist of Keep On Your Feet.

About the Author

Jeremy Ousey is the owner at Swansea's podiatry clinic: Keep On Your Feet. All the information found on this page was written by him (there's no AI or Chat-GPT here!), and has been carefully chosen to provide you with the information that you need to know about the condition. Jeremy has a Bachelor of Science in Podiatry, with honours, a Post-Graduate Certificate in Podiatric Sports Medicine, a Post-Graduate Diploma in Medical Ultrasound, and two Master's of Science degrees in the Theory of Podiatric Surgery, and Sports & Exercise Medicine. If you would like to know more about Jeremy, please click here.

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