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Big Toe Joint Pain

by Jane Hodgson 18 January 2013


Hallux Rigidus, or arthritis of the big toe joint is one of the commonest causes of big toe joint pain. Symptoms include pain and stiffness over the big toe. Treatments vary from choosing suitable footwear, using pain relief to having surgery.

One of the commonest causes of big toe joint pain is arthritis in the main joint of the big toe. Technically this is called Hallux Rigidus.

What are the Symptoms of Hallux Rigidus?

The primary symptom is pain over the top of the big toe joint often this is worse during or after any activity which involves weight bearing, such as walking or running. The big toe joint will often also feel stiff, this is generally worse first thing in the morning and on the first few steps after sitting for a while. The stiffness eases with movement.

As well as reports of where the pain is and how it behaves, an x ray taken whilst standing up is the usual way of confirming if someone has Hallux Rigidus.


What can be Done to Help?

There is no "cure" for Hallux Rigidus, but there are lots of things that will help to relieve the symptoms of big toe pain including:

  • Don't become overweight, or if overweight loose weight.
  • Use suitable footwear, flat shoes with a broad toe box and plenty of cushioning are usually best.
  • High heels bend the toe joint backwards and will be painful.
  • A shoe with a rigid sole prevents excessive movement at the big toe joint on each footstep and thus will often be more comfortable than those with a soft sole.
  • Keep the joint mobile; exercise in moderation is good even if painful.
  • It may be worth considering taking pain relief before doing an activity that is known to cause pain.
  • The use of pain relief treatments such as TENS, heat or ice offer relief.
  • A steroid injection can be put into the joint. This will normally give a good few weeks of pain relief, but is not a permanent solution.

Will Surgery Help?

Generally there are three types of surgery available to help relieve the pain of Hallux Rigidus. Most surgeons will suggest that before considering any form of surgery simple measures such as those listed above should have been exhausted, plus the pain and consequent loss of quality of life must outweigh the potential risks of surgery. Either the joint can be trimmed out, this is known as a cheilectomy, or the joint can be fused so it is rigid but not painful, or some surgeons now offer joint replacements, but these are nowhere near as developed or routine as hip or knee replacements.

A common concern when someone is considering surgery is "well I might as well have surgery because its only going to get worse right?" Perhaps surprisingly this isn't the case and actually there is a good amount of research that shows that many people develop the symptoms of pain and stiffness with associated changes on x ray in the early decades of life but these change little as the years go by. It all comes down to how much pain someone is having combined with the amount of problems this is subsequently giving them when carrying out the activities that they need to do on a daily basis.

What Else could Pain in the Big Toe Joint be?

Other causes of pain around the big toe include gout and bunions (Hallux Valgus)

Disclaimer: The information on this page is written to help you understand your injury. There are a number of possible causes for toe pain and should you have any concerns you should always seek advice from a qualified health professional such as a Chartered Physiotherapist or your GP.

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About the author

Jane Hodgson - Chartered Physiotherapist Jane Hodgson Jane specialises in lower body injuries and has raced competitively in running, orienteering and adventure racing.

Did you know

Although there are some things that make developing Hallux Rigidus more likely we don't really know why some people get it and others don't.

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