Foot and Big Toe Osteoarthritis
Arthritis in the foot, most often at the base of the big toe (hallux rigidus), where the joint becomes stiff, sore and bony on top. Stiff-soled shoes or insoles help many people, and surgery works well when they don’t.
Symptoms. Pain at the base of the big toe when walking, especially as you push off; a toe that won’t bend upwards; and a bony lump on top that rubs on shoes. Arthritis in the middle of the foot causes an ache across the top of the foot, sometimes with a bony bump.
Who gets it. More likely with age, after a toe or foot injury, when it runs in the family, and in very active people. A sudden, hot, red big toe is more likely gout.
How it’s diagnosed. From an examination of how the toe moves and where it hurts. An X-ray shows how much of the joint is affected and helps if surgery is being considered.
The big toe arthritis ladder
Start with shoes and insoles: they change how the joint is loaded with every step. Surgery is for pain that still limits you.
- Step 1 · Self-careStiff-soled or rocker-sole shoesShoes with a firm sole that doesn’t bend at the toes, or a curved “rocker” sole, and a roomy, deep toe box.
- Works
- In a trial of 102 people with big toe arthritis, rocker-sole shoes eased pain about as much as insoles, but caused more side effects and were worn less
- Cost
- From the shoes you own to about $150–250 for rocker-sole shoes
- How long
- 2–4 weeks to adjust
- Watch for
- Feeling unsteady at first, or aches elsewhere in the legs. Take care on stairs.
Flexible, bendy shoes are the enemy. Your toe wants a stiff ride.
- Step 2 · PharmacyShoe inserts (insoles)Off-the-shelf foot orthoses, sometimes with a firmer section under the big toe.
- Works
- Same trial: as good as rocker shoes and better tolerated; about 6 in 10 felt at least moderately better at 12 weeks
- Cost
- About $40–80 off the shelf
- How long
- 12 weeks to judge
- Watch for
- Rubbing or blisters while you get used to them.
The trial used off-the-shelf insoles. Ask whether custom ones are really needed.
- Step 3 · PharmacyAnti-inflammatory gel or tabletsGel rubbed on the joint, or a short course of tablets for flares.
- Works
- Can ease discomfort; no foot-specific trial figures
- Cost
- Gel about $15–30; tablets about $5–15
- How long
- As needed for flares
- Watch for
- Tablets: Stomach bleeds, kidney and heart risks. Not safe for many people: check with your GP or pharmacist.
Gel first. The big toe is close to the surface.
- Step 4 · Allied healthPodiatristChecks your walking, shoes and insoles, and can pad tender spots.
- Works
- No precise trial figures for referral itself; helps you get the shoe and insole options right
- Cost
- About $70–110 a session; Medicare rebates for up to 5 allied health visits a year with a GP care plan
- How long
- One or two visits, then reviews
- Watch for
- Choose someone who starts with simple options before expensive custom devices.
Feet are complicated. A specialist in them helps.
- Step 5 · ProcedureSteroid injection (often with joint manipulation)An injection into the toe joint, sometimes with gentle manipulation under anaesthetic as a day case.
- Works
- About half of people get relief for up to 2 years, in one UK hospital’s figures. It doesn’t cure the arthritis
- Cost
- From bulk-billed to a few hundred dollars, depending on the clinic and whether ultrasound is used
- How long
- Months to a couple of years
- Watch for
- Sore for a few weeks afterwards; rare infection.
Can buy time, especially in milder arthritis.
- Step 6 · SpecialistCheilectomy (shaving the bony lump)Removes the bone spur on top of the joint so the toe can bend more. For milder arthritis.
- Works
- About 8 in 10 succeed for up to 5 years in milder arthritis; a fusion is still possible later if needed
- Cost
- Free in the public system (expect a wait); private costs vary
- How long
- Swelling for about 3 months; improvement continues up to a year
- Watch for
- Infection, stiffness, ongoing pain.
Keeps the joint moving, which matters to runners and dancers.
- Step 7 · SpecialistBig toe fusionThe joint is fixed so it no longer bends. The usual operation for severe arthritis.
- Works
- Pain usually much less by about 6 weeks, improving up to a year. About 5–10 in 100 fusions don’t heal in the right position
- Cost
- Free in the public system (expect a wait); private costs vary
- How long
- Special shoes for about 6–8 weeks, normal shoes by about 3–4 months
- Watch for
- Smoking greatly raises the risk of the bones not joining. Some high-heeled shoes and vigorous sports become difficult.
A stiff toe that doesn’t hurt beats a bendy one that does.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- GlucosamineNICE advises against it for osteoarthritis. No good evidence for feet.
- Hyaluronic acid (“gel”) injectionsNICE advises against them for osteoarthritis.
- Expensive custom orthotics as a first stepThe trial that showed benefit used off-the-shelf insoles. Try those before paying for custom ones.
- AcupunctureNICE advises against it for osteoarthritis because the benefit is too small or uncertain.
What you can do
- Check your shoes: try bending them at the toes. If they fold easily, they’re not helping.
- Choose a deep, roomy toe box so the bony lump isn’t squashed.
- Swap some walking or running for cycling or swimming during flares.
- Keep to a healthy weight to ease the load on your feet.
See your GP if
- Pain is limiting your walking or work despite better shoes and insoles
- The toe is getting more deformed, or the lump is causing sores
- You have diabetes or poor circulation and any foot sore or skin break
- You’re not sure whether it’s arthritis, gout or a bunion
See a doctor the same day for a hot, red, swollen toe or foot with fever or feeling unwell, or a foot wound with spreading redness, especially if you have diabetes.
Common questions
Is big toe arthritis the same as a bunion?
No. A bunion is a bump on the inner side of the big toe joint with the toe drifting inwards. Big toe arthritis (hallux rigidus) causes a bony lump on top and a stiff toe that won’t bend up.
What shoes are best?
Shoes with a stiff sole that doesn’t bend at the toes, or a curved rocker sole, and a deep, roomy toe box. Low heels help too.
Do I need surgery?
Most people don’t. Shoes, insoles and pain relief are enough for many. Surgery is for pain that still limits you despite them.
Will a fusion stop me walking normally?
Most people walk well and comfortably after a fusion, but running, some sports and high heels can be harder.
Helpful resources
- RNOH: Arthritis of the big toeClear patient guide to injections, cheilectomy and fusion, including recovery times. Free, UK.
- MyOA (Arthritis Australia)Trusted osteoarthritis information, plus symptom tracking and goal-setting tools. Free, Australia.
- Arthritis AustraliaInformation sheets and the free Arthritis Infoline (1800 011 041) for questions and local support. Free, Australia.
Evidence and more information
- BMC Musculoskeletal Disorders (2017): Rocker-sole shoes vs insoles for big toe arthritis
- Trials (2014): Protocol for the rocker-sole shoes vs insoles trial
- Royal National Orthopaedic Hospital: Arthritis of the big toe
- NICE: Osteoarthritis diagnosis and management (2022)
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