DIMITRIOS BALTZIS · Patient Information
What is hallux rigidus?
Hallux rigidus is osteoarthritis of the first metatarsophalangeal (MTP) joint at the base of the big toe. Progressive cartilage damage may lead to pain, bony spurs (osteophytes) and reduced movement. Pushing off through the big toe while walking can become uncomfortable.
What symptoms can occur?
Typical symptoms include pain around the big-toe joint, stiffness, pressure from shoes and difficulty with the push-off phase of walking. With more advanced arthritis, discomfort may occur during small movements or at rest. Walking patterns may change.
How is it diagnosed?
A clinician assesses the symptoms, painful areas, range of motion and overall foot alignment. Weight-bearing foot X-rays can reveal joint-space narrowing, osteophytes and changes in the bone beneath the cartilage. Additional imaging is reserved for particular clinical questions.
What are the non-surgical options?
- Shoes with a roomy toe box and stiff or rocker-bottom soles can reduce painful movement at the joint.
- Orthoses or stiff inserts, including a Morton’s extension in suitable cases, can reduce joint loading.
- Activity modification, individually tailored physiotherapy and short-term anti-inflammatory pain treatment, when medically appropriate, may relieve symptoms.
- An injection may provide temporary pain relief for some people but does not reverse the arthritis.
When should surgery be considered?
Surgery may be considered if meaningful pain and functional limitations persist despite non-operative care. The choice depends on the severity and pattern of arthritis, range of motion, activity level and individual goals.
Which operations are available?
In earlier stages with predominantly dorsal impingement, cheilectomy removes painful bony spurs and may improve dorsiflexion. A Moberg osteotomy can be added for selected cases. For advanced, painful arthritis, first MTP joint fusion (arthrodesis) is a well-established treatment: the joint is fixed in a functional position to reduce pain, but it will no longer bend. Joint-preserving implants are considered only in selected situations after discussion of their potential limitations and failure risks.
Example radiographs
The following radiographs were supplied as preoperative and postoperative examples. Whether they document the same patient and the exact surgical procedure will be confirmed by the treating surgeon before publication.
What happens after surgery?
Recovery depends on the procedure. After cheilectomy, early guided movement may be encouraged. Following fusion, bone healing must be protected using the recommended postoperative shoe or orthosis, with clinical and radiographic checks. Weight-bearing and return to work or sport are tailored to the procedure and the patient.
What are the potential risks?
Risks include infection, wound problems, swelling, nerve irritation, blood clots and persistent pain. Following fusion, delayed healing or non-union, unfavourable position or prominent hardware may occur. Arthritis can progress after joint-preserving procedures.
References and notes
- British Orthopaedic Foot & Ankle Society (BOFAS): Hyperbook – Hallux Rigidus.
- Royal National Orthopaedic Hospital (RNOH): A Patient’s Guide to Arthritis of the Big Toe (Hallux Rigidus).
- Royal College of Podiatry: Hallux Rigidus.
Patient information · Editorial draft, October 2026. This information does not replace individual medical examination and advice.