Patient guide · Foot and ankle · 5 min read

It usually starts quietly. A bit of stiffness in the big toe first thing in the morning, a twinge when you push off on a walk, a shoe that suddenly feels too tight over the top of the joint. You put it down to age or the wrong trainers and carry on. Then one day you notice you're planning your steps around the toe, and that's when it stops being a minor niggle.

If that sounds familiar, you might have arthritis of the big toe. The good news is that there's more you can do about it than most people realise, including a new treatment for big toe arthritis that works through a very small incision. This guide walks through what's happening in the joint and the options, from simple changes to surgery.

What is big toe arthritis?

Doctors call it hallux rigidus, which simply means a stiff big toe. The joint at the base of the toe bends every time you take a step, so over a lifetime it carries a lot of load. As the smooth cartilage that cushions the joint thins, the bones can start to rub together, and the body sometimes builds extra bone around the joint.

It's more common than many people think. Around 8% of people are affected, and it tends to develop slowly. Some people have mild discomfort for years, while others end up with pain that affects walking, shoes and even sleep.

Symptoms to look out for

• A painful bony lump on top of the joint at the base of the big toe.

• Stiffness, and difficulty bending the toe, especially when pushing off.

• Swelling or tenderness around the joint.

• Pain that gets worse in tight or stiff-fronted shoes.

• In more advanced cases, aching at rest or at night.

If you recognise a few of these, it's worth having the toe looked at. An accurate diagnosis, usually with an examination and an X-ray, shows how far things have gone and which options make sense.

What you can try first

When the joint still moves reasonably well, simple measures often help. They won't reverse arthritis, but they can make daily life more comfortable.

• Shoe changes. A stiffer sole and a roomy toe box reduce how much the joint has to bend with each step. Some people find rocker-style soles helpful.

• Insoles. A specialist may suggest an insole to take load off the joint.

• Activity changes. Swapping high-impact exercise for swimming or cycling can ease flare-ups.

• Pain relief. Over-the-counter options can help, but check with your pharmacist or GP first.

When surgery comes into the picture

If those steps stop working, surgery may be worth discussing. The two procedures most commonly performed are joint-sparing surgery and fusion, and the right choice depends on how advanced the arthritis is, your age, your activity level and what matters most to you.

Joint-sparing surgery through a tiny incision

In suitable patients, a procedure called a cheilectomy can be done through a very small cut in the skin. The surgeon removes the bony overgrowth that blocks the toe from bending and causes that painful lump, but keeps the joint itself, so movement can be preserved. Because the incision is so small, this approach aims for minimal tissue injury and a quicker recovery. This is the approach that has patients asking questions, and Mr Pavel Akimau, a Consultant Orthopaedic Surgeon, is one of the few surgeons performing it through such a small incision.

Fusion

When the joint is badly worn, fusion removes the damaged joint surfaces and holds the bones together with metal implants. The toe no longer bends, but it becomes stable and strong for walking, and many people value having a long-term answer to long-standing pain.

Is keyhole surgery right for everyone?

Not necessarily. Joint-sparing surgery suits people whose joint still has reasonable movement. If the arthritis is advanced, fusion may give a more reliable result. A good surgeon will explain both honestly and tailor the choice to you, including open surgery when it's the better option. That's why the consultation matters as much as the operation.

What to expect at a consultation

Expect a conversation about your symptoms, your work and hobbies, and what you've already tried. Your foot will be examined, and imaging such as an X-ray is usually arranged. You'll then talk through the options, the likely benefits and risks of each, and what recovery involves, so you can decide at your own pace.

Frequently asked questions

Is big toe arthritis common?

Yes. Around 8% of people are affected, and it usually develops gradually over time.

Can big toe arthritis go away on its own?

Arthritis doesn't reverse by itself, but symptoms can be managed, and many people stay comfortable with footwear changes and activity adjustments for a long time.

Will I still be able to bend my toe after surgery?

Joint-sparing surgery aims to keep movement, while fusion creates a stable toe that no longer bends. Your surgeon can explain which is likely to suit you.

How long is recovery?

It varies with the procedure and the person. Your surgeon will explain what to expect for your specific operation, including when you can walk normally and return to work.

When should I see a specialist?

If toe pain lasts more than a few weeks, keeps returning, wakes you at night or limits walking, work or exercise, it's sensible to get it checked.

Final thoughts

A stiff, aching big toe doesn't have to be something you put up with. Start with the simple steps, pay attention to how the joint behaves, and don't leave it too long if things get worse. If you'd like to find out whether a new treatment for big toe arthritis could suit you, speak to a foot and ankle specialist. To book a consultation with Mr Akimau, call 07934 539252 or email help@pavelakimau.com.