Is it hallux rigidus or gout?

Hallux rigidus comes on slowly, over months or years, with a stiff toe that will not bend up and a bump on top of the joint. Gout comes on within hours, often overnight, with a big toe joint that is red, hot, swollen and too painful to touch. A joint like that needs a doctor the same day.

What is the difference between hallux rigidus and a bunion?

Both affect the big toe joint. In hallux rigidus the toe will not bend up, and the bump is a bone spur on top of the joint. In a bunion, or hallux valgus, the big toe drifts toward the second toe and the bump sits on the inner side of the joint. A doctor and an X-ray confirm which.

What shoes help hallux rigidus?

Shoes that ask the toe to bend less. Look for a sole that stays stiff at the ball of the foot when you fold it by hand, a rocker sole that curves up at the front, room over the bump, and a lower heel. A stiff insert can do some of the same work.

Can I run with hallux rigidus?

Often, with changes. Flat running in a stiff or rocker-soled shoe asks the big toe to bend less than hill repeats and stairs do, so take the hill repeats and the stairs out first and keep flat running while the ache stays mild and is no worse the next morning. A physiotherapist measures the toe bend and the calf.

Hallux Rigidus (Stiff Big Toe) Physio

Written by Zita Sham, Principal Physiotherapist at Phoenix Rehab, AHPC A1302159H.Clinically reviewed by Louise Yow, Principal Physiotherapist & Director, AHPC A1300363H.Last reviewed 7 October 2026.

Hallux rigidus is arthritis of the big toe joint, where the toe meets the foot, and it leaves the toe stiff and painful when it bends up. You feel it pushing off, walking uphill, squatting and in heels, often with a bony bump on top of the joint. A doctor confirms it, usually with an X-ray.

Key takeaways

Hallux rigidus is arthritis of the big toe joint. The toe gets stiff bending up, and a bony bump often grows on top of the joint.
It hurts most when the toe has to bend: pushing off, walking uphill, squatting, kneeling with the toes tucked under, and standing in heels.
A big toe joint that turns red, hot and swollen within hours is more often gout, and needs a doctor the same day.
A shoe with a sole that does not fold at the toe, a rocker sole or a stiff insert takes some of the bending away from the joint.
A doctor confirms it with an examination and an X-ray. An operation, such as removing the bump or fusing the joint, is a decision for your surgeon.
We measure how far the toe bends up, in degrees, against the other foot, along with the calf and the way you walk.

What is hallux rigidus?

The big toe joint is the knuckle at the base of the big toe, where it meets the long bone of the foot. Doctors call it the first metatarsophalangeal joint, or first MTP joint. In hallux rigidus the cartilage lining that joint wears thin and the bone at its edges thickens. Hallux means big toe. Rigidus means stiff. The earlier, less stiff stage is called hallux limitus.

The bump on top of the joint is a bone spur. It rubs on the shoe, and it jams against the toe as the toe bends up, like a doorstop. A spur pressing on the small nerve over the top of the joint can leave a numb or burning strip along the big toe.

It is common after 50. In a UK study of adults aged 50 and over, an estimated 7.8% had big toe joint arthritis that both hurt and showed on X-ray.¹

Why your big toe has to bend

Every step ends on the big toe. As the heel lifts, the toe bends up and your weight rolls forward over it. Walking uphill, stairs, squatting, lunging, rising onto tiptoe and standing in heels all ask the joint for more bend. When it will not give it, the foot goes around the toe. You roll off the outer edge of the foot, or lift the heel early and walk flatter.

Who gets it

Many people remember no injury. Some had a sprain of the joint years before, such as turf toe, or a fracture that ran into it. It often runs in families and often affects both feet. In one study that followed 110 people with hallux rigidus, 79% had it in both feet by the final review, and 95% of those with a family history did.²

Big toe joint hurts? Where it shows up, in the order to check

1. Pushing off, and walking uphill

The ache sits on top of the joint, or deep inside it, at the end of each step. The slope from the MRT exit up to the office. The overhead bridge stairs. The last hill of a run. Walking on the flat in a firm shoe often hurts less. Runners will find it listed in running injuries.

2. Squatting, kneeling and tiptoe

A squat with the heels down. Kneeling with the toes tucked under. A deep lunge, a burpee, rising onto demi-pointe. Each one bends the big toe as far as it goes, and the joint stops it short. Dancers will find it in dance injuries.

3. Shoes

Heels push the toe up and hold it there for the whole dinner. A soft sole that folds at the ball of the foot makes the joint bend on every step. A shallow toe box presses on the bump, and the skin over it turns red or tender. Climbing shoes curl the toes for hours, covered in climbing injuries.

4. Somewhere else in the foot

People who walk around a stiff big toe often start to ache somewhere else: under the smaller toes, along the outer edge of the foot, or in the calf. Pain under the ball of the foot has its own page, metatarsalgia.

Stiff big toe, turf toe, gout, bunion, sesamoiditis or a broken toe?

Ask three things: did it start in one moment, how fast did it come on, and which way does the toe point.

Condition	How it started	What you notice	What it needs first
Hallux rigidus (big toe arthritis)	Slowly, over months or years, often with no injury	A toe that will not bend up, an ache at push-off, a bump on top of the joint	A doctor and an X-ray to confirm it, then shoes and loading
Turf toe	One moment: the toe forced up in a tackle, a sprint start or a landing	Pain, swelling and bruising at the base of the big toe from that day	Assessment, and a doctor if you cannot walk on it
Gout	Within hours, often overnight, with no injury	A big toe joint that is red, hot, swollen and too painful for the bed sheet to touch	A doctor the same day
Bunion (hallux valgus)	Slowly, over years	The big toe drifting toward the second toe, with a bump on the inner side of the joint	Wider shoes, and a doctor if it hurts in every pair
Sesamoiditis	Weeks of running, jumping or time on the balls of the feet	Pain under the ball of the big toe, worse when the toe bends up	Load changes. See metatarsalgia
Broken toe	One moment: a stubbed toe on the bed leg, a dropped weight, a kick	Swelling and bruising, pain when you press on the bone, and a toe that may look bent	A doctor the same day, and an X-ray
Arthritis in several joints	Over weeks, in both feet, often the hands or wrists too	Swollen joints and morning stiffness that takes more than half an hour to ease	A doctor soon

Does hallux rigidus go away?

Hallux rigidus is arthritis, so the question splits in two. Pain often comes in flares, set off by a new pair of shoes, a block of hill training or a week of squats, and it often settles when the load on the joint changes. Stiffness is a separate question. We measure it in degrees, so you know which way it is moving.

Shoes for hallux rigidus: stiff soles, rocker soles and inserts

The less the toe has to bend, the less the joint is asked to do. Hold a shoe by the heel and the toe and try to fold it. If it folds at the ball of the foot, your big toe joint will bend there with every step. Look for these:

A sole that stays stiff at the ball of the foot. Most walking and work shoes can be tested in the shop by hand.
A rocker sole. The sole curves up at the front, like the bottom of a rocking chair, and rolls you forward so the toe bends less.
Depth over the toes. Enough room that the bump on top of the joint is not pressed.
A lower heel. Any heel holds the toe bent up.
A stiff insert. Some inserts carry a stiff plate under the big toe that stops it bending. See custom insoles.

In a trial of 102 people with big toe joint arthritis, ready-made foot orthoses and rocker-sole shoes reduced pain by a similar amount over 12 weeks. The orthoses group wore them more often and had fewer side effects.³

Hallux rigidus treatment: who does what

A doctor (your GP or a polyclinic doctor) examines the toe, orders the X-ray, tells hallux rigidus apart from gout and other arthritis, decides on any medication or injection, and refers you to an orthopedic foot and ankle surgeon if needed.
An orthopedic surgeon decides whether you need an operation, and which one. A cheilectomy removes the bone spur and the bump on top of the joint, to give the toe room to bend. A fusion (arthrodesis) joins the two bones so the joint no longer moves. Other operations exist. Which one, and when, is a decision for your surgeon.
A physiotherapist measures how the toe, the foot and the calf move and take load, moves the joint by hand, trains the calf and the foot, changes how you walk, run and squat around the toe, advises on shoes and inserts, and runs the rehab after surgery to your surgeon’s protocol.

Without an operation

Most of the work changes what the toe is asked to do, then builds what the foot can take. We glide the joint and the two small sesamoid bones under it by hand, train the calf and the small muscles of the foot, and change the movements that bend the toe most: a squat with the heels raised on a thin plate, a shorter stride uphill, a lunge with the back foot turned out a little. Then the load comes back in stages: the flat, the stairs, the slope, the run.

After a cheilectomy or a fusion

In the Phoenix Recovery Protocol the work starts at Calm & Protect: the wound, the swelling, the post-operative shoe and the weight your surgeon allows. Move & Mobilize differs by operation. After a cheilectomy it brings back the bend in the toe, as early as your surgeon allows. After a fusion the big toe joint does not bend, by design, so the work goes to the ankle, the smaller toes and the walk. Rebuild & Strengthen loads the calf and the foot one leg at a time. Return & Perform tests the tasks themselves: the slope, the stairs, the squat, the run and the shoes you wear to work. Your surgeon’s protocol sets the weeks. See physiotherapy after surgery.

What we measure

Big toe bend. How far the big toe bends up, in degrees, lying down and standing, against the other foot. This is the number we track at every review.
Calf. Single-leg heel raises to fatigue, counted on each leg, and whether the heel rises over the big toe or rolls out to the small toes.
Ankle bend. The knee-to-wall lunge, in centimeters, against the other leg.
Walking. Where you push off, and whether you roll to the outer edge, on the flat, uphill and on stairs.
Squat and kneel. How deep you squat with the heels down, and how long you can kneel with the toes tucked under.
Toe strength. Pressing the big toe down into the floor, against the other foot.
Your shoes. Bring the ones you wear five days a week. We fold them by hand.

Tested, not dated. The plan moves on when the measures say so.

What you can do this week

Fold your work shoes and your running shoes by hand. Wear the pair that does not fold at the toe.
Keep heels for short events, and carry flat shoes for the walk there and back.
Take the hill repeats and the stairs out of training for now, and keep flat running if the ache stays mild and is no worse the next morning.
Squat with a thin plate or a book under the heels, so the toes bend less.
Kneel with the toes untucked, on the tops of the feet, on a cushion.
Pain relief and anti-inflammatory medication are a decision for your doctor or pharmacist.

Is this normal?

Usually expected: a big toe that is stiffer first thing in the morning and loosens as you walk. An ache after a hill walk, a long evening in heels or a squat class that settles by the next day. A bump that shows more in a tight shoe. After a cheilectomy, a swollen, stiff toe for some weeks. After a fusion, a big toe joint that does not bend, which is what the operation does.

Worth getting checked: an ache at the joint that has stopped you running, dancing or wearing your work shoes for more than a few weeks. Pain under the smaller toes or along the outer edge of the foot from walking around the big toe. A toe that bends less from one month to the next. Numbness along the top of the big toe.

When to see a doctor first

Call 995 if bone is showing through the skin after an injury to the foot, if a wound is bleeding heavily and firm pressure does not slow it, or for chest pain or sudden breathlessness in the weeks after foot surgery or while in a cast or boot.
Go to the emergency department now if the big toe joint turns red, hot and swollen and you have a fever, shivers or feel unwell, which can be a joint infection. Also for a toe that points the wrong way after an injury, a foot that turns cold, pale or blue, or a calf that becomes newly swollen, warm and tender after surgery or in a boot. If you have diabetes, go now for a foot that becomes red, hot and swollen, or a wound on the foot with pus or spreading redness.
See a doctor the same day if the big toe joint turns red, hot, swollen and too painful to touch within hours, without a fever. Gout is the usual cause. Also after a stubbed toe, a kick or a dropped weight, if the bone hurts to press, the toe swells and bruises, or you cannot walk on it. After surgery, contact your surgeon the same day if the wound is red, leaking or more painful, or you have a fever.
See a doctor soon for a stiff, painful big toe that a doctor has not examined yet, aching and swelling in several joints of both feet, the hands or the wrists with morning stiffness that takes more than half an hour to ease, numbness along the big toe, or a bunion that is growing and hurts in every shoe.

Where are you with this right now?

1. It flared, and it is settling

A new pair of shoes or a hill block set it off. You changed to a firmer shoe, took the hills out, and the ache has eased week by week. The toe is still a little stiff first thing and loosens as you walk. That is a joint behaving as many do. You do not need us for this, and we would rather say so.

2. It has been months, and the toe still stops you

You bought the wide, soft shoes in March. The heels for the company dinner stayed in the box, and you stood through it in flats.

On the slope up from the MRT you walk on the outer edge of the foot without deciding to. You squat to pick up your daughter with the heel lifted. Kneeling with the toes tucked under, you last a minute, then shift onto the tops of the feet. The Sunday 10K at East Coast became a 5K, and then you stopped signing up.

Soft shoes and rest made sense for the first flare. In your own months since, the toe has not bent any further.

The ache is quieter in the flat shoes. Has anyone measured how many degrees that toe bends up, against the other one?

If nobody has examined the toe, start with your GP or a polyclinic, who can confirm it with an X-ray and rule out gout. If a doctor has confirmed hallux rigidus and the toe still stops you, one Assessment & Treatment with a physiotherapist measures the bend, the calf and your walk against the other side, works the joint by hand in the same visit, checks your shoes, and tells you which stage you are in.

3. You have had the operation, or you have a date

The surgeon removes the spur or fuses the joint. The weeks after decide how you walk on that foot, up the slope and down the stairs. See physiotherapy after surgery. Your surgeon’s protocol takes precedence.

If it is months on and you still walk on the outer edge of the foot, still cannot squat, or the calf on that side is still well short of the other one, the Stalled Recovery Review is three weeks with the same physiotherapist. The first visit measures the toe, the calf and your walk. The next two measure how they respond.

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