The Stiff Big Toe Joint

A Guide to self-help

This is a guide to help answer some questions pain associated with a stiff big toe joint. The aim is not to cover surgery, more of which can be found in my fact sheet No.3 2018. There may be a number of causes which can include bunions. Toes can remain straight and stiff or they can appear bent outwards.  fact sheet No.1 2018  The first toe is being the largest in the foot presents with a bump on the top or the side of the toe joint. Sesamoiditis is less well known condition and therefore needs its own article. However sesamoiditis will help your understanding some of the reasons for the stiff big toe.

First let us consider the causes. If the toe is bent it is called (hallux valgus) rather than a bunion.  Where the toe is stiff and painful to move pain, this is called hallux (big toe) rigidus. The permanent stiff toe might require surgery BUT temporary stiffness may not. Reading score for this article = 70

Injury as the causes of stiffness

If you force the toe upwards or backwards movement will be painful due to inflammation or damaged cartilage. Permanent stiffness may follow later. There is a lag effect meaning that the problem re-emerges a few years on.  Any physical activity such as kicking, stamping, twisting, dropping objects onto the toe could lead to a stiff big toe. Footwear may well become a problem if the toe does not bend. This is seen in the high heel shoe. Or if a bump arises, then fitting a shoe onto a swollen area may be uncomfortable

Good news. The condition may settle down and that’s the end. However, if unchecked a stiff toe joint can start to cause pain until it becomes totally locked up and doesn’t move. pain many years later.

These medical conditions associated with the study of rheumatology medicine. Further information can be found in my article on medical causes of a painful big toe.

What happens when you lose movement?

Lack of movement is the end process. When a toe does not bend you might walk awkwardly turning your foot out often known as duck footed. The stiff toe causing lack of movement changes the process of walking which means it can affect other joints higher up. These joint can include the lower back and hip joints. We need around 20-30 degrees of total movement for normal function. That means the toe can move up and down freely without pain. Walking may become painful and limiting. Painkillers and anti-inflammatories like ibuprofen fail to help. Footwear becomes a problem especially when the joint enlarges over time. This will be measured in years rather than weeks or months.

Early signs can be helped

In the early stages the muscles tighten around the big toe. This is a condition called spasm. All movement is lost at this point as the toe has limited movement – limitus. Part of the big toe joint has a small seed-like-bone called a sesamoid. These small bones are frequently involved but overlooked. The joint can jam on movement and can cause spasm  associated with sesamoiditis. Check out the article on here.

Joint oil (synovial fluid)

The surface of the bone requires lubrication and nutrition from a special greasy like oil. This is the synovial fluid. In gout, this fills with crystals of uric acid, but normally it is a clear to slightly yellow. The joint lining (synovium) produces the fluid. It is slightly stiffer when not used and better on movement and activity. Movement is therefore important to keep your joint healthy.  If the big toe becomes stiff through pain, or, if the fluid dries out, the surfaces scrape together. Once poor lubrication arises bony projections called spurs block movement. Once cartilage stiffens, loses its effectiveness bone rub on bone. The joint becomes more inflamed and cartilage is repaired with scar tissue. 

For readers who desire a more technical article you can read cartilage Damage and hallux valgus written for professionals.

Four stiff big toe joint conditions

  • Spasm due to inflammation (repeated strain)
  • Loose body (not necessarily fracture)
  • Split or worn cartilage
  • Excessive outgrowth of bone (spurs or osteophytes)

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Thanks for reading ‘Stiff Big Toe Joint‘ written by David Tollafield for ConsultingFootPain  promoting foot health awareness from the podiatrist.

Published under BusypencilCase Reflective Communications 
Originally published Oct. 2018.  Updated March 2021


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