First Toe (Metatarsophalangeal) Arthritis

First toe arthritis is a degenerative condition affecting the joint at the base of the big toe (the metatarsophalangeal joint). Also known as hallux rigidus, this condition causes pain, stiffness, and loss of motion in the joint, which can interfere with walking and daily activities. Early treatment can help manage symptoms and delay the need for surgery.

What Causes First Toe Arthritis?

First toe arthritis is the most common form of arthritis in the foot. Common causes include:

• Wear and tear (osteoarthritis)
• Previous trauma or injury to the toe
• Structural abnormalities of the foot
• Inflammatory conditions such as rheumatoid arthritis or gout
• Genetics and family history

What Are the Symptoms?

• Pain and stiffness in the big toe, especially during walking or standing
• Swelling around the joint
• A bony bump on the top of the joint
• Limited range of motion in the toe
• Difficulty wearing certain shoes

How Is First Toe Arthritis Diagnosed?

An orthopedic specialist can provide a diagnosis using:

• A physical exam to check the range of motion and pain
• A review of your symptoms and medical history, including any injuries
• X-rays to assess joint space and look for bone spurs

How Is First Toe Arthritis Treated?

Treatment depends on the severity of symptoms and how much the arthritis affects daily life.

Nonsurgical Treatments

• Anti-inflammatory medications
• Shoe modifications or stiff-soled shoes
• Orthotic inserts to reduce pressure on the toe
• Physical therapy to maintain joint flexibility
• Corticosteroid injections for temporary relief

Surgical Treatments

Surgery may be considered for patients who have persistent pain despite conservative treatment, experience significant limitations in mobility, or have joint damage. Procedures include:

• Cheilectomy: Removes bone spurs and improves joint motion
• Fusion (arthrodesis): Fuses the bones in the joint to eliminate movement and pain
• Joint replacement (arthroplasty): Replaces the damaged joint with an implant
• Osteotomy: Realigns bones to redistribute pressure

What Are the Risks?

Like any surgery, surgical treatment for first toe arthritis carries some risks, including:

• Infection
• Blood clots (extremely rare)
• Nerve damage (extremely rare)
• Ongoing pain or stiffness
• Nonunion (if fusion doesn't heal properly)
• Need for revision surgery

What Is Recovery Like?

• Varies by procedure: Recovery timelines depend on the specific surgery performed
• First few weeks: Rest and limited activity, use of crutches or a surgical shoe
• 2–8 weeks: Gradual return to weight-bearing activities
• 2–3 months: Physical therapy and return to regular footwear
• 3–4 months: Full return to daily activities and exercise

What Is the Outlook for First Toe Arthritis Surgery?

Surgical outcomes are typically very positive, with most patients experiencing reduced pain and improved function. The surgeon helps guide the patient to the most appropriate surgical choice. The vast majority of patients are very happy with the pain relief and can participate in almost all activities with little or no limitations.