Foot

What It Is

Metatarsophalangeal (MTP) joint osteoarthritis is "wear and tear" arthritis in the joints where the toes meet the foot. It most often affects the big toe joint, where it is also called hallux rigidus, or stiff big toe (AAOS, n.d.; Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023). It happens when the smooth cartilage covering the ends of the bones in the joint wears away, and bony growths (bone spurs) can form on top of the joint. These stop the toe bending as much as it needs to and can cause pain (AAOS, n.d.; Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023). It may be caused by simple wear and tear or by repeated injury to the joint (AAOS, n.d.).

Osteoarthritis is the most common type of arthritis in the UK (NHS, 2023a). It can affect any joint and causes pain and stiffness, and it becomes more likely as you get older (NHS, 2023a). Even though there isn't a cure for osteoarthritis, it does not necessarily get worse over time, and there are a number of treatments to help relieve the symptoms (NHS, 2023b). It is worth seeking help at an early stage. With treatment, most people with osteoarthritis are able to manage their pain and remain active, and surgery is only needed in a small number of cases (NHS, 2023b).

Metatarsophalangeal Joint Osteoarthritis Anatomy

In each foot, you have five metatarsal bones running from the middle of the foot towards the toes. The metatarsophalangeal (MTP) joints are where the rounded ends (heads) of the metatarsals meet the toe bones (phalanges), at the ball of the foot. The big toe joint bends every time you push off when walking.

When this joint is stiff and painful, you may have pain on the top of the joint when walking, difficulty pushing off, swelling or thickening around the joint, and you may find yourself walking on the outside of your foot to avoid the pain (AAOS, n.d.).

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

Treatment

Self-Care & Treatment

How to Treat Metatarsophalangeal Joint Osteoarthritis

Exercise is one of the most important treatments for osteoarthritis, whatever your age or fitness. It should include exercises to strengthen your muscles and exercises to improve your general fitness (NHS, 2023b; NICE, 2022). A physiotherapist can give you an exercise plan, and can use hands-on (manual) therapy to help keep your joints supple and flexible (NHS, 2023b). I can guide you through a strengthening and fitness programme, with gentle hands-on work for your toe, foot and leg. See the My Approach tab for how I work.

1. Anti-Inflammatory Medication

AAOS (n.d.) says your doctor may recommend non-steroidal anti-inflammatory painkillers (NSAIDs), taken by mouth or as a gel or cream rubbed onto the joint, to relieve the pain and swelling of a stiff big toe. The NHS (2023b) notes that some NSAID creams and gels are available without a prescription, and that NSAID tablets may not be suitable for people with certain conditions, such as asthma, a stomach ulcer or angina, or who have had a heart attack or stroke. (This medicine information comes from AAOS and the NHS, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

2. Walking Stick

Using a walking stick can help some people with arthritis in the leg or foot to move around more easily and safely by taking some weight off the painful joint (NICE, 2022). Hold it on the opposite side to the painful foot (NHS, 2023b).

3. Weight Control

Even though you might not realise it, extra weight puts extra strain on your joints and often makes osteoarthritis worse. If you are overweight, losing weight through more physical activity and a healthier diet can help (NHS, 2023b).

4. Footwear

Wear shoes with a large toe box to reduce pressure on the top of the toe, and avoid high heels (AAOS, n.d.). A stiff-soled shoe with a rocker-bottom design, or a stiff insert in the shoe, can reduce how much the big toe bends when you walk (AAOS, n.d.). I can help you work out whether one would help and how to get it, and point you to a chiropodist or podiatrist if you need a custom orthotic. Shoes with shock-absorbing soles can also ease pressure on the joints (NHS, 2023b).

5. Ice or Heat

Applying an ice pack wrapped in a cloth or towel to the toe may temporarily help ease the symptoms (AAOS, n.d.). Some people find hot or cold packs help relieve their pain (NHS, 2023b).

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

Options outside my scope

Steroid injection: an injection of corticosteroid into the joint may ease pain for a period of time, but it does not fix the problem (AAOS, n.d.; NHS, 2023b).
Cheilectomy: an operation, usually for mild or moderate arthritis of the big toe, to remove the bone spurs and part of the bone so the toe has more room to bend (AAOS, n.d.).
Fusion (arthrodesis): an operation for severe damage, in which the damaged cartilage is removed and the joint is fixed in position with screws, pins or plates so the bones grow together. This gives a stiff but usually pain-free joint (AAOS, n.d.; Norfolk and Norwich University Hospitals NHS Foundation Trust, 2023).

How I can help (see the My Approach tab)

A strengthening and fitness programme
Gentle hands-on work and mobilisation for the toe and foot
Footwear advice and help getting the right insert
Rehabilitation after surgery, once your surgeon gives the okay

Tips

Your risk of developing osteoarthritis increases as you get older (NHS, 2023a).
Maintaining a healthy weight helps to prevent undue stress on your joints (NHS, 2023a).
Osteoarthritis may run in families, and genetic factors play a part in hallux rigidus (NHS, 2023a; AAOS, n.d.).
A previous injury to a joint can increase the chance of osteoarthritis developing in it (NHS, 2023a; AAOS, n.d.).
Regular exercise that builds up muscle and strengthens the joints usually helps to improve the symptoms of osteoarthritis (NHS, 2023b).

Treatment

My Approach

Arthritis in the big toe joint is a long-term condition, so I treat it as ongoing care rather than a quick fix, with exercise at the core. My aim is to ease pain and stiffness, keep the toe moving as well as it comfortably can, and build strength in your foot and leg so walking is easier.

I start by assessing how your toe joints move and where they're 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 there too. Massage doesn't change the bony changes in the joint, so I focus on the pain, stiffness and strain that come with them.

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, with no quick or forceful movements and 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 or heat 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, and low-impact fitness such as cycling or swimming
A home programme between visits that doesn't flare the toe

Footwear and Walking

Shoes with a stiff 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
Setting up a walking stick, if you use one

If you have surgery, I need your surgeon's okay before hands-on treatment; after that I can help with swelling, the healed scar, 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. 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 Advice

Sources

References

NHS (2023a) Osteoarthritis. Available at: https://www.nhs.uk/conditions/osteoarthritis/ (Accessed: 7 October 2026).
NHS (2023b) Osteoarthritis: treatment and support. Available at: https://www.nhs.uk/conditions/osteoarthritis/treatment/ (Accessed: 7 October 2026).
National Institute for Health and Care Excellence (2022) Osteoarthritis in over 16s: diagnosis and management (NG226): recommendations. Available at: https://www.nice.org.uk/guidance/ng226/chapter/Recommendations (Accessed: 7 October 2026).
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).
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).

Massage therapy · Kitchener–WaterlooMetatarsophalangeal Joint Osteoarthritis

What It Is

Metatarsophalangeal Joint Osteoarthritis Anatomy

Self-Care & Treatment

How to Treat Metatarsophalangeal Joint Osteoarthritis

1. Anti-Inflammatory Medication

2. Walking Stick

3. Weight Control

4. Footwear

5. Ice or Heat

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

Tips

My Approach

Hands-On Treatment

Exercise

Footwear and Walking

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooMetatarsophalangeal Joint Osteoarthritis

What It Is

Metatarsophalangeal Joint Osteoarthritis Anatomy

Self-Care & Treatment

How to Treat Metatarsophalangeal Joint Osteoarthritis

1. Anti-Inflammatory Medication

2. Walking Stick

3. Weight Control

4. Footwear

5. Ice or Heat

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

Tips

My Approach

Hands-On Treatment

Exercise

Footwear and Walking

Typical Course

References

Related Conditions

Bunions

Cavus Foot (High Arches)

Claw Foot

Claw Toe

Book a session