Hallux Rigidus: When the Big Toe Joint Stops Moving

What is hallux rigidus?

Hallux rigidus is osteoarthritis of the first metatarsophalangeal joint - the joint at the base of the big toe. The cartilage breaks down, bone spurs form, and the joint progressively loses its range of motion.

For runners, the big toe needs to extend (dorsiflex) about 60–70° during the push-off phase. When this is restricted, the running gait compensates - loading adjacent structures and often causing secondary problems in the knee, hip, or back.

Symptoms

• Stiffness at the base of the big toe, especially in the morning
• Pain with dorsiflexion (bending the toe upward)
• A bony lump on the top of the joint
• Difficulty pushing off normally
• Compensatory pain in the outer foot, knee, or lower back

How to keep running with hallux rigidus

Footwear modification is the most important intervention:

• A stiff or carbon-plated forefoot significantly reduces the need for toe dorsiflexion
• A rocker-sole shoe redirects the push-off load away from the toe joint
• A toe extension orthotic (turf toe plate) provides rigidity under the toe

Exercises:

1. Seated towel toe curls - maintains what motion is left without overloading
2. Calf raises - offloads the toe joint by strengthening the ankle push-off
3. Hip strengthening - compensatory loading patterns need correction
4. Joint mobilisation - gentle traction and passive extension can maintain range; a physiotherapist can guide this

Medical options

• Corticosteroid injection - temporary relief
• Surgery: cheilectomy (removing bone spurs) works well for moderate cases. Fusion (arthrodesis) is reserved for severe cases and is compatible with continued running in many patients.

Timeline

Hallux rigidus is progressive and cannot be fully reversed, but symptoms can be managed well for years with the right footwear and exercise approach.