Hallux Rigidus: The stiff big toe

Hallux Rigidus refers to the arthrosis of the metatarsophalangeal joint. It is also called Hallux limitus or Hallux flexus. Because stretching in the metatarsophalangeal joint is no longer possible. Over time, the joint becomes more and more immobile. Most of the people affected suffer from severe pain. A long walk becomes torture. Find out everything about the Hallux Rigidus. How it arises, why it comes to that, the symptoms, what the doctor does and how to treat him.

How does a hallux rigidus develop?

The Hallux Rigidus does not develop overnight. It takes years to become very pronounced. Usually this only becomes a problem when you are over 50 years old. But it can also be a serious topic for younger people.

Over the years, our articular cartilage wears off more and more. When this happens, the body builds up bone substance around the joint to protect it. This leads to a decrease in mobility, as the joint can no longer slide. The pain is caused by jamming of the joint mucosa during stretching. This leads so far that the attachment of bone around the joint gap leads to complete immobility.

Causes of a hallux rigidus?

There are a number of possible causes of hallux rigidus. All of them cause cartilage injury or wear. Thus, the disease always proceeds in the same way.


  • Primary arthrosis, i.e. general wear and tear of the cartilage over the years
  • Repeated micro traumas due to compressions
  • Severe overstretching with cartilage injuries, e.g. during long-distance running, football and dancing.
  • Inflammatory arthritis, e.g. in rheumatism
  • Pronated feet ( flat foot)
  • Bad shoes
  • excess of weight
  • Unphysiological gait pattern

What are the symptoms of Hallux Rigidus?

Pain in the ball of the big toe is the main symptom of the disease. For this reason at least, a doctor is called in by those affected. However, there are other symptoms which can occur.


  • Pain in overstretching the big toe
  • agility deficiency
  • Toe stand is not possible
  • Pain when rolling the foot
  • signs of inflammation in the metatarsophalangeal joint: redness and swelling
  • deformation of the ball of the big toe
  • The joint is painful due to pressure
  • Pain when climbing stairs or going uphill
  • The joint gap is visible in a narrowed form in the X-ray image
  • walk with a limp
  • It is rolled over the inside of the foot with the leg turned outwards…
  • Or with the leg rotated inwards over the outside of the foot
  • This evasive movement often leads to complaints in the ankle, knee, hip, spine and thus affects the entire locomotor system and tries to solve further problems.

How is the Hallux Rigidus examined and diagnosed?

Usually the diagnosis is made quickly. Since the extension of the big toe is severely restricted.
Of course, the doctor should look at the naked foot and check the functions manually. In addition, an x-ray should be taken to determine the extent and to confirm the diagnosis. The x-ray also shows the formation of osteophytes and a narrowing of the joint space.

Differential diagnosis to gout or rheumatoid arthritis.

It should always be clarified whether it is not also another primary disease such as gout or rheumatism. This prevents premature and possibly unnecessary surgery.

To do this, the doctor should examine the blood values for the specific markers. If you suspect gout or rheumatism, I recommend that you consult a specialist. The symptoms can be alleviated by the treatment of the primary disease.

The main characteristics of gout and rheumatism are the pain that occurs in phases.

How is the Hallux Rigidus treated?

There are a number of treatment options for this disease. Both surgically and conservatively.

My first recommendation here is to pay attention to conservative therapy. An operation should be the last option, because this is a massive intervention.

The primary goal of any measure must always be the quality of life of the person concerned.

Conservative therapy without surgery

In conservative treatment, it may make sense to combine the following therapeutic measures.

Ice treatment: Cooling can reduce pain and inflammation.

injections: Intra-articular injections (into the joint space) against inflammation and pain.

Mobilization: This can increase mobility again. In case of severe pain during mobilization, the pain can be relieved beforehand with ice or injections.

Insoles: Joint bridging insoles relieve the joint and support the recovery process. Insoles for lowering the big toe. There is a recess under the toe so that it is not stretched excessively when unrolling.

Roll-off ramp in the shoe sole: This is a modified shoe sole. This takes over the rolling in the foot.

Foot baths: With additional ingredients against inflammation. Attention, too much heat can cause inflammation.

Medication: Painkillers and anti-inflammatories are an option here. Also before physiotherapy.

Rest: A reduction in sporting activity to promote healing and relieve the joint.

What shoes at Hallux Rigidus?

One recommendation is to have orthopaedic shoes prescribed by a doctor. These are exactly adapted to your foot.

MBT shoes are also an option. These ensure gentle unrolling in the shoe. When buying, you should make sure that the sole under the toes is also very thick. In doubt, trial carrying.

What insoles for Hallux Rigidus?

The same applies here as for the shoe. Your doctor can prescribe these for you. The insoles are adapted to your foot by the orthopaedist.

Usually the inlays are made of metal or very strong plastic. This makes them extremely inflexible. It is no longer possible to roll over the big toe.

A disadvantage here is that running has to be practiced anew.

Physiotherapy for Hallux Rigidus

Physiotherapy looks at the overall situation. So not only after the metatarsophalangeal joint. The therapist examines the entire body. As already mentioned above, a relieving posture can also cause far-reaching problems.

If the hallux rigidus is not very advanced.

Manual handles are mainly used here. The aim here is to increase mobility in the joint again. In addition, the surrounding joints are also treated. Usually the therapy is limited to the foot.

The Manual Handles are maltreated and compressed to provide the cartilage with nutrients. In addition, translational movements are added to keep the joint capsule flexible.

Furthermore, the metatarsal bones (metatarsal bones) are moved to maintain their function.

If there are other problems, such as flat feet or splayfoot, they are also addressed with strengthening exercises.

In advanced Hallux Rigidus

If the Hallux Rigidus is already more advanced, there are other things to consider. Thus, further accompanying problems must be investigated.

A relieving posture in the affected foot often causes problems with other joints. The therapist should also treat here.

Problematic rolling may cause pain in the shins. The knees can also cause pain. When the patient limps, pain also occurs in the lumbar spine.

Surgical Therapies

If the conservative measures are unsuccessful, surgery can be performed. There are different surgical techniques and procedures. The choice of method depends on the patient, the degree of damage and, of course, the doctor.

Common operation methods for Hallux Rigidus:

Cheilectomy: This technique is mainly used in young and active patients. Or if the bone attachments are limited to the back of the foot and are not very advanced.

A part of the two joint partners is removed. A wedge-shaped piece of bone is removed from the top of the Mettarsal head. The osteophytes are removed from the big toe side.

Arthrodesis: If the cartilage is barely present, arthrodesis is performed. Here the metatarsophalangeal joint is completely fixed with a plate and screws. The remaining cartilage is completely removed first.

The aim is for the joint to become completely ossified after the operation.

How long are you incapacitated and banned from sports?

This always depends on the profession. Since the bone has to heal, it cannot be fully loaded from the beginning.

ActivityDuration of protection
Office workApprox. 1 to 2 weeks
Working with a lot of leg work4 weeks
Craft activities6 to 8 weeks
Hikes1 month
Jogging2 months
Wearing fashionable women’s shoes3 months

Prevent a Hallux Rigidus!

The prevention of arthrosis in the metatarsophalangeal joint not only helps with this disease. But also in many situations in life.

Optimize running style

By improving one’s own running style and gait pattern, a physiological strain on all joints involved is achieved. By changing over to the bale course, the muscles can be strengthened.


Mobilize all your joints regularly. This maintains mobility.


Listen into your body and watch out for signs. If they can detect symptoms early on, the development of the disease has no chance.


Practice using your feet regularly. They strengthen muscles and ligaments. With targeted exercises not only the hallux rigidus can be avoided.

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