If your big toe joint hurts when you walk, feels increasingly stiff, or has developed a painful bump on top of the joint, the problem may not be a bunion. You could have hallux rigidus, also known as arthritis of the big toe joint.
At Stride Forward, we take a stepwise approach to treating big toe arthritis. Whenever appropriate, our goal is to reduce pain, preserve the natural joint and maintain your ability to stay active before considering more invasive treatment.
Depending on the severity of your arthritis, treatment may range from footwear changes and custom orthotics to platelet-rich plasma (PRP), low-level laser therapy, or minimally invasive joint-preserving surgery.
The right treatment depends on your examination, X-rays, symptoms, activity level, remaining cartilage and personal goals.
What Is Hallux Rigidus?
Hallux rigidus is arthritis of the joint where the big toe meets the foot, called the first metatarsophalangeal joint, or first MTP joint.
Healthy joints are covered by smooth cartilage that allows the bones to move against one another with minimal friction. With hallux rigidus, that cartilage gradually wears down.
As the condition progresses:
- The joint space can become narrower
- The cartilage becomes increasingly damaged
- Bone spurs, or osteophytes, may develop
- The big toe loses its ability to bend upward normally
- Walking and pushing off the foot can become painful
A bone spur frequently develops on top of the joint. In addition to arthritis-related pain, the spur itself can mechanically block the toe from bending and become irritated by shoes.
This combination of arthritis, stiffness and mechanical impingement is what makes hallux rigidus particularly uncomfortable for many patients.
What Does Hallux Rigidus Feel Like?
Common symptoms of big toe arthritis include:
- Pain in the big toe joint while walking
- Pain during push-off
- Stiffness or decreased motion of the big toe
- A painful bump or bone spur on top of the joint
- Difficulty wearing certain shoes
- Swelling or irritation around the joint
- Grinding or crunching when moving the toe
- Increasing preference for stiff or flat shoes
- Changing the way you walk to avoid bending the big toe
As arthritis becomes more advanced, some patients begin turning the foot outward when walking to avoid bending the painful joint. This compensation can sometimes create discomfort elsewhere in the foot.
Is Hallux Rigidus the Same as a Bunion?
No.
Although both conditions involve the big toe joint and may produce a visible bump, hallux rigidus and bunions are different problems.
A bunion primarily involves a change in the alignment of the big toe and first metatarsal.
Hallux rigidus primarily involves arthritis, cartilage damage, bone spurs and loss of motion within the big toe joint.
Some patients can have both conditions at the same time.
A clinical examination and weight-bearing foot X-rays can help determine what is actually causing your pain.
How Is Hallux Rigidus Diagnosed?
Diagnosis usually begins with a physical examination and weight-bearing X-rays.
During your evaluation, we assess:
- Where the joint hurts
- How much motion remains
- Whether pain occurs only at the end of motion or throughout the joint’s movement
- The size and location of bone spurs
- Joint-space narrowing
- Changes in the metatarsal head
- Signs of more advanced cartilage loss or arthritis
For most patients, X-rays provide the information needed to diagnose hallux rigidus. MRI, CT scans or other advanced imaging are only occasionally necessary.
What Does Stage 1, 2, 3 or 4 Hallux Rigidus Mean?
Patients are frequently told that they have a particular “stage” or “grade” of hallux rigidus.
This can become confusing because there is no single universal classification system for hallux rigidus.
For example, one commonly used system has three stages, while another commonly used system has grades ranging from 0 through 4.
That means the same arthritic joint may be described differently depending on which classification system is being used.
More important than the number are several practical questions:
How much cartilage remains?
How much motion does the joint still have?
Where and when does the joint hurt?
How much is the condition interfering with your life?
Those answers are often more useful when determining treatment than simply saying that someone has “Stage 2” or “Grade 3” arthritis.
Can Hallux Rigidus Be Treated Without Surgery?
Yes.
Particularly during the earlier stages of arthritis, treatment typically begins with non-surgical options for big toe arthritis.
The goal is to reduce inflammation and decrease the forces that repeatedly push the painful big toe joint upward during walking.
Conservative treatment may include:
- Stiff-soled shoes
- Rocker-bottom shoes
- Shoes with a roomy toe box
- Activity modification
- Anti-inflammatory medication when medically appropriate
- Physical therapy in selected patients
- Custom foot orthotics
- PRP injections in selected patients
- Low-level laser therapy in selected patients
At Stride Forward, we can fabricate custom orthotics designed around the patient’s foot structure and biomechanics. Orthotics may help reduce painful stress through the first MTP joint and decrease the amount of uncomfortable upward bending required during walking.
A Note About Cortisone Injections
Corticosteroid injections may provide temporary relief from an inflamed joint, but their role in hallux rigidus is debated among foot and ankle specialists.
One concern is the potential effect of repeated steroid exposure on remaining cartilage.
For patients who are interested in an injection treatment but want to avoid corticosteroid, platelet-rich plasma may be another option to discuss.
PRP for Hallux Rigidus and Big Toe Arthritis
Platelet-rich plasma, or PRP, is a regenerative injection treatment prepared from your own blood.
A small amount of blood is drawn and placed into a centrifuge, which separates and concentrates the platelets. The resulting platelet-rich preparation is then injected into the painful joint.
Platelets contain growth factors and signaling proteins involved in healing and inflammatory responses.
The goal of PRP for big toe arthritis is not to regrow an entirely new joint or reverse established arthritis. Instead, PRP is used in an effort to decrease pain and inflammatory activity while preserving the patient’s natural joint.
For patients who would like to consider an injection but prefer to avoid corticosteroid, PRP can therefore be an attractive option.
Does PRP Regrow Cartilage?
This is an important expectation to clarify.
PRP does not remove a bone spur, reverse established hallux rigidus or reliably regenerate cartilage that has already been lost.
Its potential role is symptom management.
The evidence also needs to be viewed appropriately. Much of the published research involving PRP for arthritis comes from larger joints, particularly the knee, rather than specifically from the first MTP joint.
Results across studies and conditions have varied.
For that reason, at Stride Forward we view PRP as a joint-preserving treatment option for appropriately selected patients, not as a cure for big toe arthritis.
Low-Level Laser Therapy for Big Toe Joint Pain
Another non-invasive treatment available at Stride Forward is low-level laser therapy, also called cold laser therapy or photobiomodulation.
Low-level laser therapy uses low-power red or near-infrared light applied through the skin over the painful area.
Unlike surgical lasers, this treatment does not cut tissue and does not generate significant heat.
Treatment is:
- Non-invasive
- Needle-free
- Typically painless
- Performed in the office
- Completed within a few minutes
- Associated with no required downtime
A short series of treatments is typically recommended rather than a single treatment.
Photobiomodulation is thought to influence cellular energy production and inflammatory signaling, with the goal of reducing pain and inflammation.
Can Cold Laser Therapy Cure Hallux Rigidus?
No.
Like PRP, low-level laser therapy does not remove a bone spur or reverse the structural arthritis inside the big toe joint.
Its potential role is to help control symptoms.
The research also has limitations. Much of the available evidence for photobiomodulation involves arthritis in other joints or other musculoskeletal conditions rather than hallux rigidus specifically, and published results have been mixed.
We therefore consider laser therapy an adjunctive, joint-preserving treatment option rather than a replacement for appropriate footwear, orthotics or surgery when surgery is clearly indicated.
Where Do PRP and Laser Fit Into Treatment?
One way to think about hallux rigidus treatment is as a progression rather than an immediate choice between “do nothing” and “have surgery.”
For an appropriate patient, treatment may progress through:
Footwear and activity changes → Custom orthotics → Additional non-surgical therapies such as PRP or low-level laser → Joint-preserving surgery when indicated → Fusion for advanced end-stage arthritis when necessary
Not every patient needs every step.
PRP and laser can also be used alongside orthotics, footwear modifications and activity changes rather than replacing them.
Both treatments may be repeated when appropriate.
Insurance coverage varies, and PRP and low-level laser therapy are frequently not covered by health insurance.
In our clinical experience, many appropriately selected patients report meaningful and sometimes lasting symptom improvement with these therapies. However, individual results vary, and we believe patients should understand both the potential benefits and limitations before choosing treatment.
When Is Surgery Considered for Hallux Rigidus?
Surgery may be considered when pain persists despite conservative treatment and begins interfering with walking, exercise, work or everyday activities.
Importantly, hallux rigidus surgery is not one single procedure.
The recommendation depends on:
- The severity of the arthritis
- How much cartilage remains
- How much motion remains
- Where pain occurs during joint movement
- Age and activity level
- The patient’s goals and expectations
Whenever appropriate, we consider whether the patient’s natural joint can reasonably be preserved.
What Is a Cheilectomy?
A cheilectomy is a joint-preserving surgical procedure commonly used for early to moderate hallux rigidus.
Rather than eliminating the big toe joint, the surgeon removes the painful bone spur and obstructing bone from the top of the metatarsal head and cleans out the joint.
This can create additional room for the big toe to bend upward and decrease the painful mechanical impingement caused by the spur.
For appropriately selected patients with usable cartilage remaining, cheilectomy can provide significant pain relief while preserving the natural big toe joint and its motion.
Minimally Invasive Cheilectomy for Hallux Rigidus
At Stride Forward, selected patients may be candidates for a minimally invasive cheilectomy.
Instead of using the larger incision associated with traditional open surgery, a minimally invasive approach allows the surgeon to address the bone spur through small incisions using specialized instrumentation and X-ray guidance.
Potential advantages may include:
- Smaller incisions
- Smaller scars
- Less disruption of surrounding soft tissue
- Preservation of the natural joint
- Potentially quicker return to shoes in appropriately selected patients
However, minimally invasive surgery is not automatically better for every patient.
Published studies have also reported potential disadvantages, including nerve irritation and the possibility of incomplete spur removal or additional surgery.
Surgeon experience and patient selection matter.
At Stride Forward, the objective is not simply to perform the smallest procedure possible. It is to choose the least invasive treatment that is reasonably likely to accomplish the patient’s goals.
Can You Avoid Big Toe Joint Fusion?
Sometimes.
For patients with early or moderate hallux rigidus who still have sufficient usable cartilage, joint-preserving treatments may allow the natural joint to remain functional.
These may include conservative treatment, PRP or laser for symptom management, or cheilectomy when a mechanical bone spur is contributing substantially to the problem.
But there is an important limitation:
No non-surgical treatment can remove a large bone spur or restore cartilage that is essentially gone.
When arthritis becomes severe and very little functional cartilage remains, attempting to preserve a badly damaged joint may produce disappointing results.
In those circumstances, first MTP joint fusion, or arthrodesis, may provide more reliable long-term pain relief.
Cheilectomy vs. Big Toe Joint Fusion
The major distinction is motion preservation versus pain relief through elimination of joint movement.
With a cheilectomy, the natural joint remains. The goal is to remove the mechanical obstruction, decrease pain and improve usable motion.
With a fusion, the arthritic joint is permanently joined together. This eliminates movement through the painful joint but also permanently eliminates motion there.
For an active patient with adequate remaining cartilage, preserving the joint may be desirable.
For a severely arthritic joint with little remaining cartilage, fusion may offer more predictable and durable pain relief.
The decision should be individualized.
What Is Recovery Like After Cheilectomy?
Recovery varies according to the procedure and the individual patient.
After either open or minimally invasive cheilectomy, many patients can walk in a protective surgical shoe or boot relatively soon after surgery.
Early motion exercises are commonly encouraged to reduce postoperative stiffness.
Swelling around the big toe is normal and may take a month or longer to settle completely.
Fusion requires a different recovery because the bones need time to heal together. Weight-bearing is typically protected during the initial healing period, followed by a gradual transition back to normal shoes and activities.
Does Cheilectomy Cure Big Toe Arthritis?
No.
A cheilectomy does not cure arthritis or replace damaged cartilage.
Instead, it removes the mechanical block created by the bone spur and can reduce pain while maintaining the patient’s natural joint.
The underlying arthritis may continue to progress over time.
A minority of patients who initially undergo a joint-preserving procedure eventually require additional treatment, including fusion. The likelihood generally increases as the severity of the original arthritis increases.
This is another reason why determining how much usable cartilage remains is so important when choosing treatment.
Our Approach to Hallux Rigidus at Stride Forward
At Stride Forward, we do not believe every painful big toe needs surgery—and we do not believe every patient should receive the same treatment.
Our approach begins with a simple question:
What is the least invasive treatment that can reasonably relieve your pain while preserving as much natural function as possible?
Depending on your individual situation, that may mean:
- Changing your footwear
- Custom orthotics
- PRP
- Low-level laser therapy
- A joint-preserving cheilectomy
- Minimally invasive foot surgery
- Or, when the arthritis is too advanced to reliably preserve the joint, discussing fusion
The goal is not to avoid surgery at all costs.
The goal is to avoid unnecessary surgery while recognizing when surgery is likely to provide the better long-term solution.
Looking for Hallux Rigidus Treatment in Boca Raton?
If you are experiencing big toe joint pain, stiffness, a painful bone spur, difficulty bending your big toe, or pain when pushing off while walking, schedule an evaluation at Stride Forward in Boca Raton, Florida.
A physical examination and weight-bearing X-rays can help determine how advanced your arthritis is, how much of the joint remains usable and which treatment options make sense for your goals.
Depending on your condition, we can discuss custom orthotics, PRP injections, low-level laser therapy, cheilectomy, minimally invasive surgery and other treatment options.
The goal is straightforward:
Less invasive when possible. More definitive when necessary. And a treatment plan designed to keep you moving forward.
Frequently Asked Questions About Hallux Rigidus
What causes pain on top of the big toe joint?
One common cause is hallux rigidus. Arthritis can produce a bone spur on top of the first MTP joint that becomes painful when the toe bends or when shoes rub against it.
Can a bone spur on the big toe be removed?
Yes. In appropriately selected patients, a cheilectomy can remove the obstructing bone spur while preserving the big toe joint.
Can hallux rigidus be treated without surgery?
Yes. Depending on the severity of the arthritis, treatment may include footwear modifications, custom orthotics, activity changes and selected adjunctive treatments such as PRP or low-level laser therapy.
Does PRP work for big toe arthritis?
PRP may help reduce symptoms in selected patients, but research specifically involving hallux rigidus is limited. PRP does not reverse arthritis or remove a bone spur. It is best viewed as a potential joint-preserving option for symptom management.
Does cold laser help hallux rigidus?
Low-level laser therapy may help decrease pain and inflammatory symptoms in some patients. Research specifically involving the arthritic big toe joint remains limited, and laser therapy does not reverse structural arthritis or remove bone spurs.
Can PRP regrow cartilage in the big toe?
PRP should not be presented as a treatment that reliably regrows cartilage lost from hallux rigidus. Its potential role is primarily symptom management.
Can hallux rigidus be treated with minimally invasive surgery?
Yes, selected patients may be candidates for minimally invasive cheilectomy. Whether this is appropriate depends on the amount and location of arthritis, remaining cartilage, symptoms and individual goals.
Do I need a fusion for hallux rigidus?
Not necessarily. Patients with earlier arthritis and sufficient remaining cartilage may be candidates for joint-preserving treatment. Fusion becomes more appropriate when arthritis is advanced and little functional cartilage remains.
What doctor treats hallux rigidus?
A podiatric foot and ankle surgeon can diagnose and treat hallux rigidus using conservative treatment, orthotics, injection therapies and surgical procedures when appropriate.
This article is provided for general educational purposes only and does not constitute medical advice or establish a doctor-patient relationship. Hallux rigidus treatment should be individualized based on a physical examination, appropriate imaging, medical history and personal goals. Schedule an evaluation with Stride Forward to discuss your specific condition.
