Foot

What It Is

Hallux osteoarthritis means degenerative ("wear and tear") arthritis of the big toe joint. The big toe joint is the joint in the foot most commonly affected by osteoarthritis (Roddy and Menz, 2018). This common condition can cause substantial pain and disability. A painful big toe joint with reduced movement can change the way you walk: some people walk on the outside of the foot to avoid pain in the big toe, which can lead to pain on the outer side of the foot (AAOS, n.d.; Lam et al., 2017).

Arthritis of the big toe joint may be the result of simple wear and tear over many years, or of repeated injuries to the big toe that damage the joint cartilage over time (AAOS, n.d.). Occasionally people remember a particular incident that they believe started the joint pain. Poor foot alignment, such as flat feet or a bunion, and genetic factors can also play a part (AAOS, n.d.).

Hallux osteoarthritis typically causes pain in the big toe joint, especially when walking, along with stiffness and reduced movement (AAOS, n.d.; Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023). The joint can look swollen or thickened, a bump may develop on top of the joint, and walking can be painful. The person may limp, or walk on the outside of the foot to protect the big toe (AAOS, n.d.).

Hallux Osteoarthritis Anatomy

The joint at the base of the big toe is called the metatarsophalangeal (MTP) joint. Just like any other joint in the body, the ends of the bones are covered with articular cartilage, a smooth, slippery covering. If this cartilage is damaged, it can begin to wear away until bone is rubbing against bone (AAOS, n.d.).

When this happens, the body lays down extra bone, forming new bone called osteophytes or bone spurs. These usually develop on the top of the joint, where they can pinch the surrounding soft tissues and restrict the toe’s ability to bend upwards when you walk (AAOS, n.d.; Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Hallux Osteoarthritis

Non-surgical treatment should be tried first, and surgery is only considered if it does not help (Lam et al., 2017; Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023). For all types of osteoarthritis, the core treatments are exercise and, if you are overweight, weight loss (NICE, 2022).

Physical therapy for this condition can include gentle mobilisation of the joint and range of movement work (Lam et al., 2017). NICE (2022) advises that there is not enough evidence to support manual therapy on its own for osteoarthritis, and only suggests considering it alongside exercise for hip or knee osteoarthritis, so exercise is the key part of your programme. I can guide you through exercises for the movement of your big toe and the strength of your foot and leg, with gentle mobilisation of the joint alongside them. See the My Approach tab for how I work.

1. Footwear

A change of footwear is a first-line treatment (Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023). A shoe with a stiffer sole or a rocker bottom reduces how much the big toe has to bend, and a shoe with a roomy toe box reduces pressure on the top of the joint. High heels are not recommended (AAOS, n.d.; Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023).

2. Ice

Ice can also help ease symptoms for a while; always wrap it in a cloth or towel rather than putting it directly on the skin (AAOS, n.d.).

3. Orthotics

Shoe inserts, such as a stiff carbon-fibre insert, can reduce how much the big toe bends when you walk (AAOS, n.d.). NICE (2022) advises that insoles and supports should not be offered routinely for osteoarthritis, only when the joint is unstable or loaded abnormally and exercise alone is not enough, so I can help you work out whether they would help you and how to get them, and point you to a chiropodist or podiatrist if you need a custom orthotic.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Steroid injection: an injection of steroid medicine into the joint, which can give short-term pain relief but does not fix the problem (AAOS, n.d.; NICE, 2022). In early-stage arthritis it is sometimes combined with moving the joint under anaesthetic (Lam et al., 2017).
Surgery: surgery may be considered depending on how severe your symptoms and arthritis are. Options include cheilectomy (removing the bone spurs on top of the joint), fusion or arthrodesis (permanently joining the bones so the painful joint no longer moves), Keller's resection arthroplasty (removing part of the joint), osteotomy (cutting and repositioning the bone) and joint replacement (Lam et al., 2017; AAOS, n.d.; Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023). If you have surgery, follow your surgical team’s own instructions for recovery.

How I can help (see the My Approach tab)

An exercise programme for your big toe, foot and leg

Gentle mobilisation of the big toe joint

Hands-on work for the foot and calf

Advice on footwear and orthotics

Tips

Arthritis of the big toe joint (hallux rigidus) usually develops between the ages of 30 and 60 (AAOS, n.d.).
The condition may follow previous injuries to the big toe, including sports injuries (AAOS, n.d.).
Genetic factors play a part, so a family history may make it more likely (AAOS, n.d.).
Since the condition develops over time, you might not realise there is a problem at first. It can be easier to treat when it is recognised early, so see a professional if your big toe is becoming stiff or painful (AAOS, n.d.).
Gout and rheumatoid arthritis are known contributors to big toe osteoarthritis (Lam et al., 2017).
If you are overweight, any amount of weight loss is likely to help (NICE, 2022).

Treatment

My Approach

Osteoarthritis of the big toe is a long-term condition, so I treat it as ongoing care rather than a quick fix. Exercise is the key part, with hands-on work alongside it. My aim is to ease pain and stiffness, keep the toe moving as well as it can, and build strength in your foot and leg so walking is more comfortable.

I start by assessing how your big toe moves and where it's sore, how you walk and push off, the strength of your calf and foot, and your footwear. Many people walk on the outside of the foot to protect the toe, so I check for aches there too.

Hands-On Treatment

Warm applications to loosen things, then work through the calf, shin and sole of the foot
Gentle mobilisation of the big toe joint and other stiff foot joints, within a comfortable range and with no quick or forceful movements, taking care where bone spurs can pinch
Work on the outer foot and other areas that have been compensating
If the joint is hot and swollen, cool applications and gentle lymphatic drainage instead, and I'll show you how to use ice safely at home

Exercise

Pain-free holds and gentle toe movement, building to calf and foot strengthening, heel raises and balance work
Strength work for the hips and legs, including gym-based work if you lift
Low-impact fitness such as cycling, swimming or walking
A home programme between visits that doesn't flare the toe during or after

Footwear

Shoes with a stiffer or rocker sole and a roomy toe box
Working out whether a stiff insert or orthotic would help and how to get it, and pointing you to a chiropodist or podiatrist if you need a custom orthotic

If you have surgery, I need your surgeon's okay before hands-on treatment; after that I can help with swelling, the scar once healed, and getting your foot moving and strong again.

What to Expect

Typical Course

Typical course: This is a long-term condition, so care is ongoing. Most people come once or twice a week at first, then weekly, with a reassessment at about 6 weeks, then every few weeks to keep things on track. Usually pain and walking start to improve within about 6 to 12 weeks of regular exercise and the right footwear.

What I Focus On

Exercise First

Gentle Joint Mobility

Calf & Foot Release

Compensation Relief

Footwear & Orthotic Advice

Sources

References

American Academy of Orthopaedic Surgeons (n.d.) Hallux rigidus (stiff big toe). OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/stiff-big-toe-hallux-rigidus/ (Accessed: 7 October 2026).
Lam, A., Chan, J.J., Surace, M.F. and Vulcano, E. (2017) 'Hallux rigidus: how do I approach it?', World Journal of Orthopedics, 8(5), pp. 364–371. doi: 10.5312/wjo.v8.i5.364
National Institute for Health and Care Excellence (2022) Osteoarthritis in over 16s: diagnosis and management (NICE guideline NG226). Available at: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations (Accessed: 8 October 2026).
Norfolk and Norwich University Hospitals NHS Foundation Trust (2023) Big toe joint arthritis. Available at: https://www.nnuh.nhs.uk/publication/download/arthritis-of-the-big-toe-joint-hallux-rigidus-v6 (Accessed: 7 October 2026).
Roddy, E. and Menz, H.B. (2018) 'Foot osteoarthritis: latest evidence and developments', Therapeutic Advances in Musculoskeletal Disease, 10(4), pp. 91–103. doi: 10.1177/1759720X17753337

Massage therapy · Kitchener–WaterlooHallux Osteoarthritis

What It Is

Hallux Osteoarthritis Anatomy

Self-Care & Treatment

How to Treat Hallux Osteoarthritis

1. Footwear

2. Ice

3. Orthotics

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise

Footwear

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooHallux Osteoarthritis

What It Is

Hallux Osteoarthritis Anatomy

Self-Care & Treatment

How to Treat Hallux Osteoarthritis

1. Footwear

2. Ice

3. Orthotics

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

Hands-On Treatment

Exercise

Footwear

Typical Course

References

Related Conditions

Hallux Rigidus

Bunions

Cavus Foot (High Arches)

Claw Foot

Book a session