Hallux Rigidus(or osteoarthritis of the big toe)

Hallux Rigidus

Definition, Causes & Origins

Hallux rigidus is the osteoarthritis of the big toe. In contrast to the hallux valgus where we find a significant deformation of the big toe but with a normal and painless mobility, in the hallux rigidus there is almost no deformation of the big toe but the mobility is very restricted and especially painful. This is due to cartilage degradation.

Osteoarthritis of the big toe may result from old trauma (shock, crushing, sprain, dislocation or fracture), rheumatoid disease (rheumatoid arthritis), or infection (bacterial arthritis), but most often is “idiopathic”: i.e., with no obvious cause in the present state of knowledge. It can affect all ages, genders and occupations.

No causal factors.


Diagnosis is not always straightforward. At first, the foot looks normal although the patient has pain walking. On examination, big toe motion is limited and, above all, painful. Sometimes, cartilage and bone debris accumulates (osteophytes) and deform the top of the toe, making footwear problematic. Standard foot X-ray easily reveals the osteoarthritis, in the form of joint impingement. Cartilage thickness is reduced, and the bone surfaces are in direct contact with one another.

Big-toe motion is restricted and painful.


Painful stiffness is the key symptom in osteoarthritis of the big toe. In hallux valgus, pain is caused by friction against shoewear, but here big-toe motion is almost always painful, on walking, running, standing on tip-toes, barefoot or not.

Pain walking, even barefoot.


A - Surgical treatment

Surgery is the real treatment, especially in advanced cases. Sometimes, we can shave off the excess bone around and above the toe. In other cases, bone cuts (osteotomies) are suitable, to treat painful impingement. Prostheses are rarely used, as results are not so good as in the hip or knee. In severe cases, the reference treatment is toe-joint fusion (arthrodesis): once fused, the toe can no longer move, but pain is completely and definitively abolished.

Advanced painful osteoarthritis

A few videos to better understand

Advanced painful osteoarthritis

Advanced painful osteoarthritis bis

B - Non-surgical (medical) treatment

-The first step is medical treatment. But this only serves to relieve pain, and does not stop the lesions worsening. Pain-killers make the disease easier to bear, but after a while this is not enough.
-Wide footwear and, especially, rigid soles can reduce pain at first.
-Cortisone injections in the joint provide some relief and help patients get through the worst moments.
-Viscosupplementation injections seem promising, according to the first studies.


When to have surgery?

When you are suffering too much. It’s the patient who decides whether finally to undergo surgery.

Can both feet be operated on at once?

Technically, yes; but in fact it’s a bad idea. Operating on both feet in one step, for example:
- increases surgical risk (of infection, phlebitis …);
- delays getting out of bed and beginning to walk again;
- increases operative time;
- rules out same-day-discharge and simple locoregional anesthesia, which has been a real progress in terms of both complications and postoperative pain;
- and means operating on the second foot, which is rarely at the same stage of deformity as the painful foot.

What kind of anesthesia is recommended?

Local, definitely… It relieves postoperative pain better, is less dangerous, and is ideal for outpatient surgery.

Is foot surgery, and hallux rigidus surgery in particular, painful?

Yes, in theory … But nowadays local (locoregional) anesthesia not only controls pain during surgery but also relieves postoperative pain. Nothing to hesitate about!

Outpatient or classical inpatient surgery?

Outpatient care used to seem unsuited to foot surgery, because the patient would have to walk out of the hospital the same day. Here in France, we were slow to come around to the new techniques, even when they had become widespread in the rest of the world. Under pressure from the health authorities, however, we adopted day surgery – with excellent results for all concerned. What could be better for the patient than to go back home for the night? – especially with at least one foot on the ground. Modern locoregional anesthesia has transformed postoperative course: less pain, and less of the side effects of general anesthesia.

Can you walk and run?

Yes, you can walk and run painlessly.

When can you put your shoes back on?

Straight away – but with an orthopedic shoe. Comfortable sports shoes are possible by the third week.

When can you get back to work?

As soon as the bones consolidate: as of week 6. But if you have a sedentary job or your job can be adapted, then you may be able to start work again sooner.

When can you start driving again?

As of week 6 – or earlier if the bones have consolidated and wearing shoes is possible.

Can you wear high heels?

Yes, as of week 6 you can wear 5-6 cm (2 inch) heels without difficulty. Any higher, it’s not forbidden, but it is a bit harder.

Can you put your weight on your foot straight away?

Yes, because the surgical assembly is solid from the start.

After big-toe fusion (arthrodesis), you can wear high heels, walk, go hiking …

Information about anesthesia