Osteoarthritis of the big toe (Hallux rigidus)
What is it?
Osteoarthritis can also affect the foot and the big toe. Osteoarthritis is a wear and repair process. In the big toe it is also known as hallux rigidus (Latin for ‘stiff great toe’).
It can lead to joint pain with limitation of movement, which can affect daily activities. Osteoarthritis is the most common type of arthritis, affecting approximately 9 million people in the UK.
Versus Arthritis have produced a summary of ‘What is osteoarthritis?’ in the video below.
In osteoarthritis we see changes to the cartilage of the joint as well as other secondary changes such as inflammation. Cartilage helps our joints move freely. Changes to the cartilage can lead to pain, stiffness, and loss of movement.
It most commonly affects people older than 45 and is more common if you are overweight, have a family history of it, or have previously injured the joint in question. Osteoarthritis has varying degrees on functional limitation and effect on quality of life. Contrary to popular belief it does not affect everyone as you get older and does not necessarily get worse with age.
How to manage it
There are a number of things you can try to help improve your symptoms. A number of people are able to live with osteoarthritis of the big toe. Please follow some of the self-management advice below.
Orthoses/Insoles
For big toe problems such as osteoarthritis (hallux rigidus) or a stiff big toe (functional hallux limitus). An insole or orthotic that reduces the movement of the joint may help.
These insoles can be bought online or in a shop, however, if you need further advice please speak to a health care professional.
Footwear
For osteoarthritis shoes with rocker sole modifications may also help. Rocker soles may be necessary to reduce motion at the joint which in turn reduce pain.
Wearing high heeled shoes may worsen your symptoms.
Simple painkillers
Painkillers like paracetamol will ease the pain, but need to be taken regularly in order to control the pain. Always follow the instructions on the packet.
Anti-inflammatories like ibuprofen can help with swelling, and therefore help you move more freely. Topical (applied directly on the affected body area) anti-inflammatories are recommended initially. Follow the instructions on the packet and discuss using them safely with a pharmacist, especially if you have any underlying health conditions
However, you should not take ibuprofen for 48 hours after an initial injury as it may slow down healing.
Up to date guidelines can be found on the NHS website:
Other medicines can help to reduce inflammation, swelling and pain. You should discuss this with your GP if the simple pain relief advice does not help or if you are needing to take ibuprofen for more than 10 days.
Ice Therapy
Some people find using ice on the hot, swollen area can help.
Use a damp cloth containing an icepack (or bag of frozen peas) on the painful area to help numb the pain. Apply it for up to 20 minutes, up to three times a day.
- People should be cautious using these treatments if they have altered skin sensation or circulatory problems.
- Check the skin regularly during and after the ice pack application
- Stop if there is excessive pain, numbness or tingling
- Do not put ice directly on to the skin as this may cause a burn.
Exercises
Regular exercises for your ankle and foot are important. Stretches can help to reduce the pressure on the front of your foot and can improve your symptoms.
Stand in a walking position with the leg to be stretched straight behind you and the other leg bent in front of you. Take support from a wall or chair.
Lean your body forwards and down until you feel the stretching in the calf of the straight leg.
Hold approx. 30 secs. relax. Stretch the other leg. Repeat 3 times.
Stand in a walking position with the leg to be stretched behind you. Hold on to a support.
Bend the leg to be stretched and let the weight of your body stretch your calf without lifting the heel off the floor.
Hold approx. 30 secs. – relax. Repeat 3 times.
Select ‘Exercises to stretch tight Gastrocnemius muscles’ and ‘Stretches for tight Soleus muscles’ for a video of the exercises.
It is important to do both these exercises.
Usually a combination of improving your muscle flexibility and wearing orthotics in your shoes considerably reduces your pain.
Surgery and injections
If inflammation (synovitis) is present, injection of a local corticosteroid and anaesthetic may be useful. Surgery may be needed if things are not improving with self-management discussed.
If your symptoms are not manageable please discuss with your GP for further advice.
