Big Toe Arthritis

Name: Big Toe Arthritis (Hallux Rigidus)
Creator: Prof Paul Lee

Big toe arthritis (hallux rigidus) is one of the most common forms of foot arthritis. It causes pain and progressive stiffness at the base of the big toe, affecting every step you take.

Reviewed byProf Paul Lee MBBch, FRCS (Tr & Orth), PhDLast reviewed 1 May 2026

Understanding hallux rigidus

The first MTP joint bears up to 60% of body weight during the push-off phase of walking. When cartilage wears and bone spurs form, this essential movement becomes painful.

Pain at the top of the big toe joint, particularly when bending the toe upward.
A visible bony bump on the top of the joint from spur formation.
Progressive stiffness reducing the ability to walk, run, or wear certain shoes.

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Treatment options

Stiff-soled shoes or carbon fibre plates to limit painful joint motion.
Injection therapy (steroid, HA, PRP) for pain management.
mFat biological treatment to support cartilage and reduce inflammation.
Cheilectomy or fusion for advanced cases that do not respond to conservative care.

The goal is to maintain the joint for as long as possible. Every month of preserved movement is a month of normal walking mechanics.

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Professor Lee discussing treatment options

You may have more options than you think

Most patients have more treatment options than they have been told

At London Cartilage Clinic we follow a structured clinical framework across four areas of treatment. Before recommending a single procedure, we assess which combination of approaches gives you the best outcome.

Preserve

Protect what you have. Slow degeneration and manage symptoms.

Repair

Fix specific damage. Torn tissue, unstable joints, structural problems.

Regenerate

Rebuild lost tissue. Biological treatments that stimulate new growth.

Replace

When other options are exhausted. Joint replacement as a last resort.

Explore the full range of treatments available for your joint. Each hub page shows every option we offer, organised by clinical approach.

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Frequently Asked Questions

What is hallux rigidus?

Hallux rigidus is arthritis of the first metatarsophalangeal (MTP) joint at the base of the big toe. It causes the joint to stiffen and lose its normal range of motion, making push-off during walking painful and difficult.

How does big toe arthritis affect walking?

The big toe joint is critical for the toe-off phase of gait. When it stiffens, the foot compensates by altering walking mechanics, which can lead to pain in other parts of the foot, knee, or lower back.

What non-surgical treatments are available?

Options include stiff-soled footwear or carbon fibre insoles to reduce joint stress, steroid or hyaluronic acid injections, PRP, mFat therapy, and physiotherapy. These can provide meaningful relief and delay the need for surgery.

When is surgery needed?

Surgery is considered when pain and stiffness significantly limit walking despite non-surgical treatment. Options include cheilectomy (removing bone spurs to improve movement) and fusion (arthrodesis) for advanced cases. Your specialist will discuss which approach suits your stage of arthritis.

Still have more specific concerns?

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