Big Toe Joint Pain & Stiffness

What is Big Toe Joint Pain?

It is essentially osteoarthritis of the big toe joint where the cartilage wears down between joint and you get gradual “bone on bone” rubbing that results in pain, enlargement of joint and progressive stiffness.

Who gets it?

People of all ages and walks of life, particularly if you have previous big toe joint pain or if your foot structure predisposes you to it. It is often termed as wear and tear of the joint but is not limited to older individuals.

How is it diagnosed?

A clinical exam by a podiatrist, podiatric surgeon or orthopaedic surgeon would be able to determine the degree of the problem in terms of pain and quality of movement. Xrays are used to assess the joint and any changes around it. Occasionally, we request an MRI scan if we are uncertain of the cartilage quality especially in very early problems that are not detectable on X-rays.

What can be done?

Before surgery is recommended you can manage the pain with over the shelf anti-inflammatories or pain medicines. Footwear advice and use of specialise orthotics can help prevent progression of the problem and reduce pain by supporting the joint.


Cortisone injections help reduce the inflammation of the joint and thus the pain. This is usually a temporary solution or for patients with very early acute symptoms.
Injections such as Ostenil or Hyaluronic acid substitutes can provide lubrication that is naturally lost in the arthritic process.

Surgery for Hallux Rigidus / Stiff big toe?

The choice of big toe surgery procedures largely depend on the degree of osteoarthritis and patient expectations and life styles.
Cheilectomy: This involves shaving the boney lumps and bumps that cause pinching in shoes and enlargement of joint. It is mostly used in mild osteoarthritis.
Osteotomy: This involves cutting and resetting bones around the big toe joint to increase space around joint or improve functional alignment. Used if Osteoarthritis is mild and in the young with obvious deformity or pathology.
Fusion: This procedure has been considered gold standard for moderate and severe osteoarthritis and has the best evidence base. Predictable outcome and long term resolve of problem with unlikely risk of recurrent joint complaint. The big toe is fused to stop al painful movement in joint.
Joint Replacement: This procedure allows you to retain movement in the joint. Most procedures are used in the older patient with lower activity levels.

Further Developments for Big Toe Joint Pain:

Newer techniques are continuously being developed and we will be happy to provide you with an accurate diagnosis and advise on appropriate choice of procedure for your problem.
Please visit our extensive Patient information section or call us on 0207 820 8007 for an appointment or advice.