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Hallux rigidus - the stiff big toe

from UXGO
July 18, 2019, 13:32 p.m.

Hallux (Latin for big toe) rigidus (Latin for stiff, rigid) is one of the most common disorders of the big toe. Specifically, it affects the metatarsophalangeal joint of the big toe. Stiffness and immobility in the big toe are the consequences of this arthrosis. Like any other arthrosis, it is a symptom of old age that simply occurs due to wear and tear. It mainly affects people over 50.

It hurts, it presses, it throbs and unsightly bone bumps appear at the metatarsophalangeal joint of the big toe, then everything points to hallux rigidus. Unfortunately, just putting your foot up and waiting doesn't help. The following text explains exactly what hallux rigidus is, what causes it and how you can get help without an operation.

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What is Hallux rigidus


Also known as the stiff toe, the hallux is rigidus, immobile at the top and bottom. This can not only be painful, but also restricts mobility, and thus walking, considerably, because rolling over the big toe is blocked.
High heels, shoes that are too tight or previous accidents often lead to incorrect loading of the foot, whereby the joints of the big toe, but also of the metatarsal bone, are incorrectly or too extremely loaded. This problem is not always inevitably self-inflicted. Hallux rigidus can be genetically inherited. It therefore does no harm to inform yourself in advance whether a family predisposition exists.

What exactly happens to the metatarsophalangeal joint of the big toe?

The older we get, the greater the wear and tear on the body. The consequence of this is arthrosis, i.e. the wear of the cartilage, which loses its buffer function. This in turn leads to strong friction between the bones and the joint. To protect the worn cartilage, bone outgrowths form. Usually a bump appears on the bone, which acts like a stopper for the lower bone and thus causes stiffening, since the big toe no longer has any room to move. The pressure of the shoes on the bony bulge leads to redness and pain. Depending on the stage, the metatarsophalangeal joint of the big toe can almost be destroyed and can only be saved by a hallux operation.

"Hallux Rigidus is one of the more common diseases of the foot. Risk factors are earlier injuries of the joint. Many patients have a genetic predisposition. These are mainly those who develop it on both sides. But there are also some metabolic diseases, for example gout, which destroy the metatarsophalangeal joint of the big toe or rheumatism."
Prof. Dr. Markus Walther, Medical Director and Chief Physician, Schön Klinik München Harlaching

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Causes and risk factors


The metatarsophalangeal joint of the big toe must be able to withstand a very high load even in a healthy state, since it is unrolled when walking over the big toes. If certain negative factors occur, or if the joint is permanently subjected to disproportionate stress, the joint will be damaged and the joint space narrowed. This in turn triggers inflammation and finally arthrosis of the metatarsophalangeal joint of the big toe. This results in stiffening of the joint, which is no longer painful, but leads to considerable difficulties when walking. A complete stiffening of the joint is therefore also called hallux limitus (lat. limited). The joint gap is completely closed and the metatarsophalangeal joint is thus completely immobile.

Concrete triggers for hallux rigidus have not yet been fully clarified. The following causes and risk factors are known:

  • shoes too tight or too small
  • severe obesity
  • genetic factors
  • malposition of the feet
  • growth anomalies
  • injuries

If one or more of these factors occur over a longer period of time, this can lead to a hallux rigidus.



Hallux rigidus develops during a process that can continue for many years until the metatarsophalangeal joint of the big toe is completely stiffened. However, once the joint has become stiff, any damage that has already occurred cannot be reversed. Nevertheless, there are various treatment methods that can slow down or even temporarily stop the process of stiffening.

  • You can recognize advanced arthrosis of the big toe by the following symptoms:
  • Swelling of the big toe
  • Aches
  • Rubbing noises when moving
  • Calluses
  • Twitching of the foot muscle


"The swelling's gotten worse and worse. When I go out, dance, the foot is swollen three days later. I have to cool it down, lie in bed and my foot throbs."
Sophia Schönborn, patient

Diagnosis and therapy


If you are plagued by regular pain or if you see the first signs of hallux rigidus, it is important to react in time to take the right steps. Therefore, pay conscious attention to the symptoms listed above and do not delay your visit to the doctor too long.

Your doctor will make a diagnosis on the basis of the symptoms and will use an initial anamnesis to identify the risk factors in order to ensure the best form of therapy and to stop and properly treat the arthritis of the metatarsophalangeal joint of the big toe.

Self-Profileaxe: Always make sure you wear the right footwear. Your shoe should always have the right fit, both in width and size. In this way you prevent the hallux rigidus and avoid aching feet.


Treatment methods


Treatment of osteoarthritis of the metatarsophalangeal joint of the big toe and the associated hallux rigidus varies depending on how far the stiffening has progressed and what causes it.


Conservative treatment methods

At the beginning of the disease, conservative methods can prevent surgery and relieve pain and strain on the joint. Shoe insoles are particularly suitable for this purpose. The splint in the sole reinforces the foot and ensures normal rolling and reduces the strain on the metatarsophalangeal joint of the big toe.

If you react in time, you can prevent complete stiffening.

Hallux rigidus exercises

In addition to the insoles, there are certain physiotherapy exercises that are designed to maintain mobility. The earlier you start, the better you can prevent stiffness and counteract pain.
Stretching exercises are particularly recommended for Hallux rigidus. The big toe is not stretched, as might be assumed, but other structures of the foot suffering from the incorrect loading. Ligaments and muscles in particular are subjected to involuntary strain, as many people adopt a gentle posture as a result of hallux rigidus. The stretching exercises alleviate or even completely prevent any subsequent problems.

A light stretching exercise for at home:

Put your hands around the affected foot
You touch the sole with 4 fingers of each hand, the thumbs are on top of the foot.
You press the sides of your feet down and use your fingers to smooth out the arch of the foot. This stretches your tendon plate.


Toe pull 

Now grasp your toes with both hands and press them down as far as possible, so that a slight pull on the back of the foot occurs. Hold this position for 20 seconds.
This will stretch the back of your foot.

Ball roller

In order to keep the joint mobile, there are some mobilization exercises. All you need is a tennis ball. Place the affected foot on the ball and roll it back and forth with light pressure. This exercise can be done while sitting or standing. 30 repetitions are enough to stretch the tendon plate and mobilize the arch of the foot.

Grab' to

Another very pleasant exercise is the gripping exercise. For this you need small handy objects like berries, marbles or similar. Sand is also very good. Fill the chosen object into a bowl and grab it with your toes.

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When doing the grasping exercise, make sure that no warm objects are used in case of inflammation - cold objects, on the other hand, have a soothing effect. Ice cubes or frozen peas are particularly suitable in this case and are wonderfully cooling.

Hallux rigidus - surgery


If the arthrosis has progressed considerably and the metatarsophalangeal joint of the big toe is already very stiff, only hallux-rigidus surgery can help. In the first case, the resulting mechanical blockage can be released by the bones of the joint. Excess parts of bone and cartilage are removed to restore mobility.
Another variant, which is usually used if the patient already has severe pain, is surgical stabilised stiffening. In this case, the mobility of the joint is not restored, but is immobilised in a controlled manner. The patient is painless and not further restricted. Even after a hallux-rigidus operation one is normally mobile and can practice all kinds of sports without any problems.