The stiff big toe (HALLUX RIGIDUS) is a painful progressive pathological condition of the foot that concerns the 1st metatarsophalangeal joint. It appears in people over 50 years of age. Essentially, it is the development of arthritis, wear and tear of the articular cartilage of the joint consisting of the head of the 1st metatarsal and the proximal phalanx of the big toe. It can be combined with bunions (hallux valgus), but it can also occur without this deformity.


  • Previous joint injury and gradual onset of post-traumatic arthritis.
  • Pre-existing foot conditions such as flat feet or clubfoot as well as bunions can lead to the development of a stiff big toe
  • Genetic factors


  • Pain in the big toe which makes it difficult for the patient to walk and progressively also to rest.
  • Stiffness of the 1st metatarsophalangeal joint which leads to a change in the walking model resulting in burdening the more central joints such as the knee, hip and lumbar spine.
  • Edema (swelling) and inflammation of the joint as a result of which the patient cannot wear his shoes and is limited to the use of special shoes (soft and roomy)

Hallux rigidus.  X-ray: 1st metatarsophalangeal arthritis (red circle)


Applying ice topically can temporarily relieve symptoms of pain and stiffness. It is preferable to soak the foot in a basin of cold water for about 5-7 minutes several times a day rather than immediately applying a local ice pack.

Patients with a stiff big toe are preferable to wear shoes made of textile material so that it adapts to the deformations of the foot and does not create local pressures on the protrusions. Inside the shoe, it is preferable to apply a rigid sole, following a foot scan, in order to create conditions for stiffness of the metatarsophalangeal joint, avoiding pain.

Local injection of cortisone in the affected joint helps to calm the inflammation and temporarily treat the pain. Also the combination with hyaluronic acid injection can improve the result of the therapeutic approach.


The removal of the osteophytes of the 1st metatarsophalangeal joint is an excellent treatment option in the initial stages of the problem, i.e. before arthritis and permanent stiffness develop. Removal of osteophytes restores movement and normal function of the big toe, neutralizing pain.

Αφαίρεση των οστεοφύτων από τη 1η μεταταρσοφαλαγγική άρθρωση.
Arthrodesis of the 1st metatarsophalangeal joint is the final treatment option in advanced stages of the disease. By removing the arthritic articular surfaces, the cause of the pain is neutralized and the patient improves his quality of life by maintaining the normal walking pattern. The operation is performed under general or spinal anesthesia and the patient can leave the clinic the same day wearing a special shoe - splint for 6 weeks. With this shoe he can walk and exercise the operated leg immediately after the surgery. The operation is painless and bloodless.

Preparation of the articular surfaces of the 1st metatarsophalangeal joint for arthrodesis.

Arthrodesis of the 1st metatarsophalangeal joint with a special anatomical MEDARTIS titanium plate

Post-op X-ray.  1st metatarsophalangeal joint arthrodesis

Arthro Heal Clinic, www.arthrohealclinic.gr link image