Hallux Rigidus (Big Toe Arthritis) Treatment
in Los Angeles
Medically Reviewed by Dr. Pegah Panirian, DPM, foot and ankle surgeon
Overview
Hallux rigidus is osteoarthritis of the joint at the base of the big toe. The cartilage inside the joint wears down and a ridge of bone builds along the top. The toe stops bending upward as far as walking requires. Dr. Pegah Panirian, DPM, a leading Los Angeles foot and ankle surgeon, treats it at The Feet Institute.
She is board certified by the American Board of Podiatric Medicine and board qualified by the American Board of Foot and Ankle Surgery. Before she discusses any operation she stages the joint on examination and a standing x-ray, because the stage determines which operations are still possible.
Key Points
- Not a bunion. A bunion pushes the toe sideways and its bump sits on the inside of the foot. This stiffens the toe, and the bump sits on top.
- Stiffness comes first. You will usually lose upward bend months or years before the joint hurts at rest.
- A visible bump means it is advanced. By the time you can see a bump on top of the foot, spurs have formed and cartilage has worn.
- Appointments. Dr. Panirian sees new patients the next day at the Los Angeles/Beverly Hills and Westchester offices. Same-day depends on her schedule.
What Is Big Toe Arthritis (Hallux Rigidus)?
Big toe arthritis and hallux rigidus name the same condition, osteoarthritis of the first metatarsophalangeal joint. That is where the first long bone of the foot meets the first bone of the toe. You load it at every step, and you need roughly 65 degrees of upward bend to walk normally.
As the cartilage thins, the bone ends rub and new bone grows along the top of the joint. You can feel that overgrowth through a shoe, and it physically blocks the toe from lifting. Surgeons call the earlier phase hallux limitus, when you have lost some upward bend but not all of it. In the late phase the cartilage is gone.
A bunion is a different condition, and you can have both at once. A bunion mainly limits which shoes fit. Hallux rigidus mainly limits push-off.
| Bunion | Hallux rigidus | |
|---|---|---|
| Direction the toe moves | Sideways, toward the second toe | It stiffens in place |
| Bump location | Inside edge of the foot | Top of the joint |
| What it limits | joint congruity, foot width and comfort | Upward bend, and pushing off |
What Does Big Toe Arthritis Feel Like?
The pain sits on top of the joint or deep in the joint, comes on with movement, and eases at rest. Patients usually report some combination of the following.
- Pain pushing off. It is sharpest as the foot leaves the ground, sometimes deep in the joint, more often across the top.
- The toe will not bend up far enough. You roll around the joint instead of over it, and you change your gait to compensate.
- A bump on top of the foot. Patients and clinicians both mistake it for a bunion or a callus. The skin over it reddens where a shoe rubs.
- Stiff when you first get up. It is worst on waking and after sitting still, and it eases once you have been moving.
- Pain along the outside edge of the foot. You walk on the outside of the foot to spare the big toe, which loads the outer metatarsals instead.
- Your shoes stop fitting. Thickening around the joint often pushes you out of your usual shoes before the pain does.
Constant pain at rest, or pain that wakes you at night, usually does not fit this pattern. Ask for an earlier appointment if that is what you have.
What Causes Hallux Rigidus?
Most patients have no single identifiable cause, and in most cases nothing you did brought it on.
- Years of walking. You put body weight through this joint at every push-off, and the wear accumulates over decades.
- A previous injury. A stubbed or fractured big toe, or repeated injury in sport, can damage the cartilage surface.
- Foot shape. A long first toe, a high arch or a bunion alters how the joint loads.
- Previous forefoot surgery. A stiff, painful joint after bunion surgery is a common reason patients come in.
- Family history. Inherited foot shape contributes, which is why Dr. Panirian asks whether a parent or sibling had the same stiff toe.
What Happens If a Stiff Big Toe Is Left Untreated?
Progression is usually slow, over years. The joint will not return to normal on its own and the ridge of bone will not dissolve.
- Fusion becomes the only option. Joint-preserving operations need cartilage left to preserve. Once it has worn through, fusion or a joint replacement are what remain.
- Transfer pain under the ball of the foot. Walking on the outside of the foot to protect the big toe overloads the outer metatarsals. That overload causes pain of its own, called transfer metatarsalgia, and it needs treating separately.
Researchers compared joint-preserving with joint-sacrificing surgery in 26 patients and found similar improvements in pain and function from both [4]. The series is too small to be conclusive. Dr. Panirian still tries the joint-preserving operation first where cartilage remains, because it leaves a revision option open if needed in the future. .
How Is a Stiff Big Toe Diagnosed?
Dr. Panirian examines the foot, then confirms the diagnosis on a standing x-ray. She separates pain deep inside the joint from pain limited to the bump on top, because the two lead to different operations.
If the pain is only over the bump, removing the bump often relieves it. If the toe hurts through its whole range of movement, the cartilage surface is worn and spur removal alone is unlikely to help.
Two things you can check yourself put you roughly in one of three stages. The first is how far the big toe bends up compared with your other foot. The second is where in that bend the pain starts. Dr. Panirian assigns the stage from those plus the x-ray.
| Stage | What you notice | What the x-ray adds |
|---|---|---|
| Early | The toe bends up nearly as far as the other side. Pain comes at the very end of the bend | A small spur, most of the joint space still there |
| Moderate | Upward bend is clearly reduced, and you can see or feel a bump on top | A larger spur and narrowing joint space |
| Severe, end-stage | The toe barely bends, and pain comes through the middle of the bend as well as the end | Little or no joint space left |
These are what she uses to place you on that scale.
| What she checks | What it shows | When she does it |
|---|---|---|
| Physical examination | Available motion, where in the arc the pain starts, spur position, and how the foot moves when you walk | Every visit |
| Standing x-ray | Spur size, remaining joint space and cartilage loss. Joint space narrows only under weight, which is why you stand for it | Every visit |
| CT scan | Alignment of the forefoot | When alignment is the question |
| MRI | Cartilage, bone and the ligaments around the joint | When the x-ray does not explain the pain |
What Are the Treatment Options at Each Stage?
Non-surgical care comes first at every stage, and many patients get enough relief from it to need nothing else.
- Shoes. A stiff-soled or rocker-bottom shoe with a wide toe box reduces how far the toe has to bend.
- Orthotics. A custom made insert with certain biomechanics corrections can allow more movement of the joint. In some, a rigid carbon fiber insert under the big toe, called a Morton’s extension, inside an ordinary shoe works best.
- Anti-inflammatory medications. You take these by mouth or rub them into the skin, with ice, for pain and swelling.
- A corticosteroid injection. Dr. Panirian injects the joint to relieve pain for several months. It does not repair cartilage, and repeated injections can damage it further.
- Physical therapy. Most useful while the toe still bends, to hold the motion you have and correct the mechanics around the joint.
The degree figures below come from a retrospective series of 153 patients, followed for a mean of 26 months [3]. Researchers recorded the upward bend each operation gained by twelve months.
| Stage | Operation | Does the toe still bend? | What is removed | Extra upward bend at 12 months |
|---|---|---|---|---|
| Early to moderate | Spur removal (cheilectomy) | Yes | The ridge of bone and a portion of the toe bone | 16 degrees |
| Early to moderate | Keyhole surgery on the joint (first MTP arthroscopy) | Yes | Less bone than an open procedure | No published figure |
| Moderate | Shortening the long bone (decompression osteotomy) | Yes | A slice of the metatarsal, to shorten the pull | 30 degrees |
| Moderate | Shortening the long bone with a partial implant | Yes | A slice of the metatarsal, plus one worn surface | 24 degrees |
| Moderate to severe | Resurfacing one side of the joint (partial or hemi implant) | Yes | The worn surface on one side | 20 degrees |
| Severe, end-stage | Replacing the joint (silicone implant) | Yes | Both worn joint surfaces | No published figure |
| Severe, end-stage | Fusion (arthrodesis) | No | The joint | None |
In a fusion, Dr. Panirian removes the damaged cartilage and holds the bones together with screws or a plate until they unite. The pain stops because the worn surfaces no longer move against each other [1]. She performs spur removal and keyhole surgery through a minimally invasive incision where the joint allows it.
Which Implant Does Dr. Panirian Use, and Why?
Where the joint surface is gone and the priority is keeping the toe bending, Dr. Panirian implants a silicone joint, or a partial implant in selected patients. She uses the Swanson and Vilex silicone designs.
| Silicone implant | Partial (hemi) implant | Fusion | |
|---|---|---|---|
| What it replaces | Both worn surfaces | One worn surface | Nothing; the bones unite |
| Does the toe bend afterwards | Yes | Yes | No |
| How well it works | 99.1 percent still in place and 90.1 percent of patients satisfied at a mean of four years, across 117 procedures [2] | 20 degrees of extra upward bend at 12 months, against 16 after spur removal alone [3] | The most predictable route for pain in a joint worn through [1] |
| How it can fail | Loosening over years, then revision surgery. Complications in 8.9 percent of that series, including two deep infections | Loosening, or wear of the surface left in place | Non-union, or transfer pain in nearby joints |
The 117-procedure figures come from a single-center retrospective series, not a trial.
How Long Does Recovery Take?
The ranges below will vary depending on your individual circumstances, which Dr. Panirian will discuss with you at your appointment [1].
| Operation | What you wear on the foot | How long swelling lasts |
|---|---|---|
| Spur removal (cheilectomy) | A stiff-soled sandal for at least two weeks | Several months |
| Fusion (arthrodesis) | A splint or cast for the first six weeks | Three to six months |
Your age, whether you smoke, whether you have diabetes, and how much of the joint Dr. Panirian had to work on all shift those ranges. She will start you moving the toe early after a spur removal, because an unused joint stiffens again.
Why Choose Dr. Panirian for Big Toe Arthritis Treatment in Los Angeles
- Board certification. She is board certified by the American Board of Podiatric Medicine, and board qualified by the American Board of Foot and Ankle Surgery.
- Cedars-Sinai residency and teaching. Her surgical residency was at Cedars-Sinai Medical Center, where she served as chief resident in her final year and now teaches as an attending.
- Hospital affiliations. She operates at three Los Angeles hospitals: Cedars-Sinai Medical Center, Cedars-Sinai Marina del Rey Hospital and Providence Saint John’s Health Center.
- Minimally invasive training. Continued training in minimally invasive foot and ankle surgery, used where the joint allows it.
- Expert in every operation for this joint. Spur removal, keyhole surgery, bone shortening, partial and silicone implants and fusion, both joint-preserving and joint-sacrificing.
- Languages. She sees patients in English, Spanish and Farsi.
Dr. Pegah Panirian, a leading Los Angeles foot and ankle surgeon, performs cheilectomy, fusion and arthroscopy at her practice. With a patient-centered approach, Dr. Panirian targets treatment to your lifestyle goals and comfort. Using minimally invasive technique, she reaches the joint through small incisions, easing pain and protecting the movement you have left.
At your first visit she examines the toe, takes a standing x-ray and goes through what each operation would achieve for your joint. Where cartilage remains, joint-preserving surgery keeps your own toe bending. Where it has worn through, fusion gives reliable, lasting relief.
Book a consultation at the Los Angeles/Beverly Hills or Westchester office to find out how much bend you could get back.
Common Questions About Big Toe Arthritis
What is the newest treatment for big toe arthritis?
Minimally invasive spur removal and keyhole joint surgery are the newer approaches for early and moderate arthritis. Implant designs have improved for late-stage joints. Dr. Panirian chooses between them on how much cartilage the x-ray shows, not on how new the technique is.
Can big toe arthritis be reversed?
No. Cartilage that has worn away does not grow back, and no treatment restores it. Footwear and orthotics reduce how far the toe has to bend, which reduces the pain. Surgery removes the bone or the joint surface blocking it. Patients who stay in stiff-soled shoes and rigid inserts often keep an early-stage joint comfortable for years without surgery.
Is hallux rigidus surgery worth it?
That depends on how much the toe limits you and how much movement you are prepared to lose. Patients in one comparison reported similar improvements in pain and function whether the surgeon preserved the joint or fused it [4]. At 26 patients that series is too small to settle the question.
What shoes help a stiff big toe?
A stiff sole with a rocker bottom and a wide toe box, or a rigid carbon fiber insert fitted inside an ordinary shoe. High heels force the joint further into the bend that already hurts, and usually worsen the pain. You can see the full range of conditions and treatments the practice covers.
Sources
- Hallux Rigidus (Stiff Big Toe). OrthoInfo, American Academy of Orthopaedic Surgeons. Accessed September 22, 2026.
- Silastic Joint Arthroplasty as a Joint-Preserving Alternative for End-Stage Hallux Rigidus: Outcomes From 112 First Metatarsophalangeal Joint Arthroplasties. Cureus, 2023. DOI 10.7759/cureus.46561.
- Comparison Outcomes of Cheilectomy, Hemi-Implant Arthroplasty and Decompression Osteotomy for the Treatment of Hallux Rigidus: A Retrospective Study of 153 Patients. Journal of Foot and Ankle Surgery, 2025. DOI 10.1053/j.jfas.2025.03.009.
- Clinical Outcomes After Joint-Preserving and Joint-Sacrificing Surgery for Hallux Rigidus. Cureus, 2023. DOI 10.7759/cureus.42155.