Foot & toes
Hallux rigidus: big-toe arthritis
A stiff, painful big-toe joint: footwear adaptations, cheilectomy and fusion.
Understanding the condition
Hallux rigidus is arthritis of the joint at the base of the big toe. Pain may occur on push-off or where a bony spur rubs against a shoe. Examination and X-rays assess arthritis and whether pain occurs mainly at the end of movement or throughout it.
Treatment options
A wide toe box, stiff or rocker sole, insoles and suitable medication can help. An injection may offer temporary relief. If symptoms remain limiting, the extent of arthritis and your goals guide surgical choices.
What a procedure may involve
Cheilectomy removes impinging bone spurs in selected earlier disease while retaining joint motion. Fusion prepares and fixes the joint so it heals as one bone, usually for more advanced arthritis. Fusion permanently removes motion at that joint; the smaller joint near the toe tip still moves.
Risks and benefits to discuss
The aim is less pain during walking and in shoes. Cheilectomy may leave ongoing pain or be followed by progressive arthritis and later fusion. Fusion has risks of nonunion, an unsuitable position and prominent metalwork. Both have infection, scar, nerve and blood clot risks.
Any operation also carries bleeding and anaesthetic risks. Occasionally, complex regional pain syndrome causes prolonged pain and sensitivity. Your health and the extent of surgery change your personal risk.
Rehabilitation and aftercare
Keep the wound protected, elevate and wear the advised shoe. Loading and toe exercises depend on the procedure: movement may be encouraged after cheilectomy but should not be forced across a fusion. X-rays may guide progression after fusion.
Expected outcomes and recovery
Recovery takes weeks to months, with swelling often lasting longer. Cheilectomy does not prevent arthritis progression. Fusion may give dependable pain relief but limits footwear choices and some activities. Discuss shoes, occupation and sport before choosing surgery.
When to seek urgent help
Seek prompt advice for rapidly increasing pain, spreading redness, wound discharge, fever, new numbness or a cast or boot causing pressure. New calf pain or swelling needs urgent assessment. Chest pain or breathlessness needs emergency help: call 999.
Your consent discussion
Ask which treatment best addresses your symptoms, what alternatives are reasonable, what the main risks mean for you, and what recovery will involve at home and work. This guide supports that discussion; consent is completed with your treating team. Your individual written instructions take priority.
Your consent discussion
Use the patient pack to record your priorities, the proposed procedure, its alternatives, the benefits you hope for and risks that matter to you. A clinician will discuss your individual circumstances and complete the appropriate hospital consent process with you.
Reading or downloading a guide does not give consent. You can ask further questions, decline treatment or change your mind before the procedure.
Further reading & sources
Prepared 10 October 2026 for the practice of Mr Peyman Bakhshayesh. Professional background. General patient education; your clinical assessment and written instructions determine your care.
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