Hallux rigidus, also known as big toe arthritis, affects adults — usually between the ages of 30 and 50 — and is typically the result of a previous sports injury. So, what hallux rigidus treatment is available?
Symptoms of hallux rigidus
Most people present with pain at the base of the big toe. Sports such as running or football make the pain worse, while a stiff, supportive mid-foot shoe usually improves symptoms. Other common symptoms include swelling at the base of the toe and a lump at the joint (a bone spur). Activities such as stairs, running, and push-ups may be unbearable.
There’s usually a history of a toe injury many years ago — an acute injury often termed “turf toe”.
How is hallux rigidus diagnosed?
We diagnose hallux rigidus by clinical examination and imaging. On examination, the ability to move the joint up and down is reduced compared with the other side, and tenderness is usually over the top of the joint rather than beneath it. Other toe conditions, such as sesamoiditis or gout, must be ruled out.
Weight-bearing X-rays show reduced joint space and cartilage wear. Ultrasound or MRI can show the extent of cartilage loss, swelling, and inflammation.
Hallux limitus vs rigidus: are they the same?
Broadly, yes. Hallux limitus refers to the stiffness of the big toe joint, also known as turf toe. We think hallux limitus leads to hallux rigidus if the symptoms aren’t treated properly, so limitus is best thought of as an earlier stage.
Gout vs hallux rigidus
Gout is an inflammatory arthritis caused by uric acid crystals that build up in the joint, leading to intense pain and inflammation. Gout leads to episodes of severe pain and swelling followed by periods of few symptoms, and these episodes aren’t usually affected by activity, unlike hallux rigidus.
Hallux Rigidus Treatment Options
There are non-surgical and surgical options. In a recent study of over 700 patients, 55% were satisfied with conservative management.
Shoes and orthotics for hallux rigidus
The first step is to get your footwear right. A stiff-soled shoe limits toe movement, and a rocker-bottom orthotic helps the foot transition from heel to toe, supporting the joint. Reducing or limiting impact activity, such as running, also helps.
Ibuprofen tablets before and after provoking activity help in the short term. Physical therapy — mobility exercises and strengthening of the foot, calf, and muscles above — reduces the load on the big toe. Finally, a cortisone shot can reduce pain and improve movement.
Do you need surgery for hallux rigidus?
We should only consider surgery after simple treatments. There are two main types:
- Cheilectomy (shaving the bone) — a good option for sizeable bone spurs on the joint surface. The limitation is that, although the spurs are removed, the underlying arthritis remains so that the spurs can return.
- Arthrodesis (joint fusion) — sacrifices joint movement for reduced pain. This is helpful for end-stage disease.
A cortisone shot for hallux rigidus
Like other injections, a cortisone shot for hallux rigidus works better when combined with treatments such as physical therapy and orthotics. Cortisone is a potent anti-inflammatory that reduces pain and swelling in an arthritic joint. The effect usually lasts a few months (sometimes longer), and repeated cortisone injections can harm the cartilage and may accelerate arthritis.
We perform the cortisone shot under ultrasound guidance so the cortisone reaches the correct spot and works more effectively. See our dedicated page on the cortisone shot in the big toe joint for more on the injection itself.
Some doctors use other injections after cortisone, such as hyaluronic acid or platelet-rich plasma (PRP). There isn’t strong evidence that these are effective, but some people benefit from a trial, with a preference for gel (hyaluronic acid).
How much does a cortisone shot for hallux rigidus cost?
Dr Masci performs a one-stop appointment — consultation, diagnostic ultrasound, and the injection in a single visit. At the Chelsea clinic (the most cost-effective location), a consultation with an ultrasound-guided cortisone injection is £400; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about hallux rigidus
Does a cortisone shot work for hallux rigidus?
Yes — a cortisone injection reduces pain and swelling in the arthritic joint, usually for a few months, and works best alongside orthotics and physiotherapy. We limit how often it’s repeated, as frequent cortisone injections can harm the cartilage.
What’s the difference between hallux limitus and hallux rigidus?
Hallux limitus is the stiffness of the big toe joint (turf toe)—an earlier stage. Hallux rigidus is a form of arthritis characterised by reduced movement and bone spurs. Untreated hallux limitus tends to progress to hallux rigidus over time.
How do you tell gout from hallux rigidus?
Gout causes sudden, severe episodes of pain and swelling from uric acid crystals, with symptom-free periods in between, and isn’t tied to activity. Hallux rigidus causes gradual, activity-related pain and stiffness. A blood test and examination help tell them apart.
What are the best shoes for hallux rigidus?
A stiff-soled shoe that limits movement of the big toe, often with a rocker-bottom sole or orthotic to help the foot roll through from heel to toe. Getting footwear right is the single most effective first step.
Does hallux rigidus need surgery?
Not usually — most people manage well with footwear, orthotics, activity modification, and sometimes a cortisone injection (over half are satisfied with conservative treatment). Surgery — a cheilectomy for spurs, or a fusion for end-stage arthritis — is reserved for cases that fail these measures.
Can you run with hallux rigidus?
Often, with modification — a stiff-soled shoe, reduced mileage, and good foot and calf strength. If running keeps flaring the toe despite these changes, switching to lower-impact exercise while it settles is sensible.
Final word from Sport Doctor London about hallux rigidus treatment
We usually see hallux rigidus in younger adults who’ve had a sports injury to the toe. Try simple remedies first — footwear, orthotics, and activity modification — before considering injections or surgery.
If you have big toe pain and stiffness, Dr Masci can assess you in London, including an ultrasound in the clinic. Contact the team here or call +44 (0) 203 488 0350.
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