Big Toe Osteoarthritis – symptoms, diagnosis and treatment

The first metatarsophalangeal joint (MTPJ) in the big toe (also known as hallux rigidus) is the joint in the foot most commonly affected by osteoarthritis. There are no clear prevalence* estimates of big toe osteoarthritis and the prevalence rate in studies range from 2,5 – 39%.  Big toe osteoarthritis mostly affects adults aged 50 and above.

Symptoms of big toe osteoarthritis

The main symptom of osteoarthritis in the big toe is pain or tenderness. This pain may get worse when putting weight on the foot, for example when walking or running.

Common symptoms of big toe osteoarthritis include:

• Painful or achey big toe (both during activity and after resting)
• Stiffness
• Reduced mobility (e.g. difficulty bending the toe)
• Swelling
• Walking difficulties

The big toe may also start to push against the other toes, which can create a bunion (hallux valgus). This may cause even more pain when walking. Bunions are bony lumps that form on the side of the big toe for various reasons. However, bunions are not necessarily a sign of osteoarthritis. Over time, bunions may lead to hammertoes. A hammer toe is a crooked toe next to the big toe. 

If you experience any of these symptoms you should schedule an appointment with a physical therapist or a doctor to get a diagnosis.

Several risk factors play a part

There is no single cause for the development of osteoarthritis and several risk factors tend to play a role. A traumatic injury (e.g. spraining, fracturing or stubbing your toe) is a main risk factor for big toe osteoarthritis. Research has found that the inflammatory condition gout also increases the risk of osteoarthritis of the big toe.

General risk factors for osteoarthritis of any joint are injuries, genetics, obesity and female sex. Since our feet support and balance our entire body, excess body weight puts a lot of strain on the whole foot.

How big toe osteoarthritis is diagnosed

Traditionally, osteoarthritis was diagnosed by X-ray. Today, it is still a widespread belief that this method is necessary for diagnosis. However, according to the World Health Organization and extensive international research, osteoarthritis should be diagnosed by a physical therapist or a doctor through an assessment based on the patient’s medical history, joint function and pain level.

The healthcare professional will also take risk factors for osteoarthritis into account and keep them in mind when establishing the diagnosis. If you experience pain or stiffness in your big toe, a good first step is to contact your primary healthcare center and schedule an appointment with a physical therapist or a doctor to receive the right diagnosis.

Treating osteoarthritis of the big toe

First-line treatment options for big toe osteoarthritis is self-management. This includes the use of foot orthoses, shock absorbing soles and comfortable shoes with rocker soles. Shoes with rocker soles can support the feet which may alleviate pain in the big toe. Foot orthoses, which are custom designed shoe inserts, have been associated with reduced joint pain in the big toe. 

Individualized exercises for the foot and big toe obtained by a physical therapist may help to strengthen the toe and reduce pain and stiffness. However, there is not enough scientific evidence to determine the efficiency of exercise for the big toe.

Walking sticks, support bandages or tape may also provide symptom relief for some patients.

As a complement to first-line treatment, if the pain becomes unbearable, non-prescription painkillers can be used for short periods of time. You should however always discuss the use of painkillers with your doctor to avoid side effects and drug interaction.

Other treatment methods

If first-line treatment options aren’t providing enough symptom relief, other treatments can be offered.

On occasion, cortisone injections are used as a complement to treat severe big toe osteoarthritis. These injections only offer short-term symptom relief and should be administered by an experienced orthopedic specialist. Cortisone injections should be used with caution and only when symptoms are not alleviated by first-line treatment, as excessive injections may further damage the joint.

In rare cases, surgery may be necessary. Although surgery can provide good results for many patients, it is never risk-free. All surgery comes with the risk of developing infections. The most commonly performed surgical procedure for osteoarthritis of the big toe is a cheilectomy.  A cheilectomy is the removal of excess bone from the toe joint. Other surgical options include an osteotomy (to remove bunions) and joint fusion surgery. Most of these operations are performed under local anesthesia. 

*Prevalence is a term for the number of people in a population affected by a disease.