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Did you know that there are a total of 33 joints in the foot alone that make it work and operate?! Our bodies are amazing! However, if one of those joints is having an "off day", doesn’t have the mobility it should, or has pain in it, it can start to cause issues up and down the whole lower extremity. One common culprit of pain is the big toe. This is a very common place for arthritis to occur, and unfortunately, when arthritis flares it can make us not want to participate in our daily sports and leisure activities.
What can be done? Lots! In this article, we will give you some actionable tools to get back on your feet (literally) and show you exercises for big toe arthritis.
What Causes Big Toe Arthritis?
Arthritis itself is a general term that encompasses more than 100 diseases. The main symptom of arthritis is swelling (inflammation) in and around the affected joint. Arthritis is considered ‘progressive’, but can be very manageable over time with the correct amount of exercise and medical management. Learn more about limitations in big toe mobility and bunions by watching the video below!
Big toe arthritis is often known as ‘hallux rigidus’, and can occur in both young and elderly individuals. It is more common in individuals over fifty, with 1 in 40 individuals in this age category having big toe arthritis. Curious about other forms of arthritis and what you can do? Check out our blog on all things hip arthritis below!
READ: EXERCISES FOR HIP OSTEOARTHRITIS
Hallux rigidus is translated to ‘stiff big toe’ - very fitting, as this is the main cause of the pain with big toe arthritis. The stiffness mainly occurs in the MTP (metatarsophalangeal joint) where the base of the toe meets your foot. Hallux rigidus is considered a form of OA, or osteoarthritis. It tends to be more common in females. (1) There are a variety of causes for hallux rigidus can include:
- Repetitive microtrauma in active individuals and athletes
- Previous fracture of the big toe
- Medical conditions such as rheumatoid arthritis or gout (more on that below)
- Stubbing your toe
- Turf toe (sprain of the big toe)
- Anatomically longer toe bones than usual
Common symptoms of big toe arthritis include:
- Pain and stiffness
- Swelling/inflammation
- Loss of range of motion of the big toe, or not being able to comfortably move it
- Bunion or callus on top of the big toe
Other Things to know about Hallux Rigidus
As mentioned, big toe arthritis and hallux rigidus can be considered progressive, and there is a grading scale to quantify how difficult it is to move your big toe.
Hallux rigidus grades include:
- Grade 0: Your affected toe can move 10-20% less than your other big toe.
- Grade 1: 20-50% less movement in your affected big toe.
- Grade 2: 50-75% less movement.
- Grade 3: 75-100% less movement.
- Grade 4: 75-100% less movement with more severe pain while moving your affected toe.
A note about gout: Gout is a condition that is often confused with big toe arthritis, mainly because it occurs in and around the joints of the foot and toes. However, gout is a metabolic condition that causes increased production of uric acid in the circulation, causing microdeposits or “crystals” in the tissues. This causes progressive sharp pain and weakness, leading to the inability to walk and get around. While hallux rigidus is more common in females, gout is more common in males aged 40 or older and is strongly linked to poor dietary habits and increased alcohol intake. (2)
Treatment and Management of Hallux Rigidus
While surgery can be done for hallux rididus, we HIGHLY recommend conservative treatment! Various treatment options can be very effective for this condition without the risk of surgery. You may consider:
- Changing your footwear: Certain types of footwear such as high heels and narrow shoes can restrict movement in the foot and toes and cause additional pain and restriction.
- Supportive pads or pressure relievers inside the shoe can help to cushion painful areas.
- P.O.L.I.C.E principle: protection, optimal loading, ice, compression, and elevation
- Over-the-counter pain relievers can be very helpful in reducing pain and inflammation
And of course, an ESSENTIAL, MUST-HAVE piece of any good conservative management program is EXERCISE!
Below are some good stretching techniques and exercises you can try to curb that big toe pain!
Exercise 01 of 04
Exercise demonstration
Ankle Dorsiflexion Mobilization - Static
View exercise instructions
- HOW: Get your foot set-up and supported on an elevated surface while balancing on the other leg. To perform the mobilization, bring your knee and shin bone forward over your toes while keeping your heel down on the ground. While driving the knee forward, also attempt to drive the knee slightly outward towards you pinky toe.
- FEEL: You should feel a stretch in your calf and your ankle.
- COMPENSATION: Keep your entire heel flat on the ground as best as you can
You may be wondering why we are talking about big toe pain but showing you an ankle exercise. Well, remember what we said at the beginning about how a lack of mobility in one place can cause a lack of mobility in another? Sometimes, we see with a lack of big toe mobility we also have limited ankle mobility thus, working on our ankle dorsiflexion mobility can be key to helping with your big toe discomfort.
Exercise 02 of 04
Exercise demonstration
Seated 1st MTP Extension Mobilization
View exercise instructions
- HOW: In a seated position, cross the involved leg and foot over the other leg’s knee with your ankle hanging unsupported. Grab your foot around the ball of your foot stabilizing the whole foot with that hand. With the other hand, gently pull your big toe straight out as you move it up and down for the prescribed amount of reps.
- FEEL: You should feel a gentle stretch in your big toe joint.
- COMPENSATION: Don’t move your foot, focus the movement only in your big toe.
Time to isolate that big toe! With the above exercise, as mentioned, gently pull your big toe out and up. This will assist with providing some increased space in the joint which will lead to a healthier and happier joint!
Exercise 03 of 04
Exercise demonstration
Big Toe Extension - AROM
View exercise instructions
- HOW: Get set up in a seated position barefoot with your foot resting on the ground. To perform the exercise, raise your big toe while keeping the other toes flat on the floor. Don’t allow the foot to roll out as you perform this, this may give you a false sense of big toe elevation.
- FEEL: You should feel your foot muscles working to perform this exercise and control the motion. It may be challenging and even frustrating at first, but try to relax your foot and 'try less' versus tensing up. The more you practice this the better you will get at isolating the big toe and the greater the range of motion you will be able to go through.
- COMPENSATION: Avoid the urge to excessively flex and curl the little toes while they rest on the ground, just use a little pressure. Try to keep the rest of your leg above your foot/ankle 'quiet' and relaxed.
Time to strengthen! Yes, the above exercise may feel hard and frustrating! That is ok and normal. The muscles that control these movements are small and let's keep in mind that the signal to move these muscles travels a long way from the brain! Keep practicing and with consistency, you will notice improvement!
Exercise 04 of 04
Exercise demonstration
Heel Raise - Big Toe Extension
View exercise instructions
- HOW: Place a folded towel on the ground in front of you. Position both of your big toes on the towel with the balls of your feet still on the ground. Use a wall for balance support as you keep your knees straight and raise your heels off of the ground with your toes pushing into the towel.
- FEEL: You should feel a stretch in the bottom of your big toe and underneath your foot.
- COMPENSATION: Keep your big toe on the towel, not all of your foot. Keep your knee straight when raising your heel.
Closing Thoughts
Big toe pain and arthritis can be a real nagging and annoying condition! However, it can be effectively managed with a good rehab program and the right conservative measures as discussed in this article. Try some of these techniques to stay on your feet with big-toe arthritis!
LEARN MORE ABOUT OUR FOOT AND ANKLE REHAB & PREHAB PROGRAMS
References
- Cho, N. H., Medicine, P. D. of P., Kim, S., Rheumatology, R. D. of, Kwon, D.-J., Surgery, P. D. of O., Kim, H. A., Rheumatology, P. D. of, & Lee, K. B. (2009, April 1). The Journal of Bone and Joint Surgery. British volume. Bone & Joint Publishing. https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.91B4.21925.
- Vizcaino-Luna Y, Bermúdez-Marrero W, Bermúdez-Marrero W, Egües-Mesa J, Cárdenas-Domínguez T, Prendes-García E. Gout Arthritis. Ten years of follow up. Revista Cubana de Reumatología [Internet]. 2019 [citado 19 Feb 2024]; 21 (3) Disponible en: https://revreumatologia.sld.cu/index.php/reumatologia/article/view/717
About The Author
Taryn Beaumont, PT, DPT, CLT, CF-L1, CNC
[P]rehab Writer & Content Creator
Taryn was born and raised in Maine and still resides there with her fiancé and son. Taryn received her Doctorate in Physical Therapy from Husson University in 2010, and also carries a Bachelor's in Kinesiology and Human Movement Science. She is a Certified Lymphedema Therapist, a Certified Crossfit Level 2 Trainer, and a NASM Certified Nutrition Coach. Taryn has 12+ years of experience in many different realms of PT, from the young athlete to the geriatric patient. Most recently she is employed with a home health PT company and is working toward her Advanced Competency in Home Health. Taryn considers herself a ‘lifelong learner’. She has special interests in oncology care and breast health, dry needling, and CrossFit training. In her free time, Taryn enjoys fitness, spending time with her family, continuing education, writing, and reading, and is very excited to be a part of The [P]rehab team to educate and empower others to take control of their health and wellness.