Many patients can have difficulties with pain in their first toe joint.  This can often be secondary to a bunion which is related to malalignment of the 1^st toe or great toe joint (usually inherited but also caused by fashionable shoes).  One other common cause of 1^st toe pain is arthritis of the 1st MTP joint (great toe joint or the metacarpal phalangeal joint) which is often called hallux rigidus (hallux is the large toe, rigidus if stiffness related to arthritis/bone spurring).   

Arthritis is a condition in which the cartilage or the gliding surface of a joint wears out.  The joint does not move as smoothly and the joint motion is decreased. The body attempts to repair the joint by producing inflammatory chemicals that cause pain.  New bone is produced to protect the joint leading to bone spurs that further decrease motion in the joint. Arthritis of the large toe joint can occur after a first toe injury (such as a turf toe injury), however most patients report no prior injury.

Patients with Hallux Rigidus have pain in their large toe joint with walking or exercise.  Shoes can be difficult to wear secondary to spurring around the joint. Examination of the foot demonstrates that the joint may look larger secondary to the bony spurs.  The motion of the joint is decreased.

Most patients with Hallux Rigidus can be managed without surgery.  Shoes that have more room in the front of the shoe as well as stiffer shoes (in which the 1^st toe joint does not need to move) can be helpful.  Often patients are sent for orthotics/carbon fiber insoles that support the 1^st toe joint.  Other options would include anti-inflammatory medications or a corticosteroid injection. 

Surgery can be required for increasing difficulties.  Options include removal of the bony spurs in patients with lower grade arthritis.  If the arthritis is more significant and especially if motion of the joint is already limited, a fusion of the joint is done. In a fusion, the bones of the joint are compressed with screws and a plate to eliminate any motion of the joint.  Motion is eliminated however the pain is markedly decreased.  

There are surgeries that can be done to decrease pain with maintenance of motion.  An interpositional arthroplasty is a procedure in which the capsule or lining of the joint is divided and placed into the joint.  This acts as a new gliding surface to decrease pain. This surgery can also be performed with tissue from the tissue bank. Joint replacements (metal and plastic such as that done for knee replacement) have been done for the 1^st toe joint, however the long-term results have not been great.  They often loosen and need to be removed. Cartiva is a different type of implant that can be used for hallux rigidus.  In this procedure poly vinyl alcohol (looks similar to a segment of silicone) is placed in the joint to act as a spacer between the two bones and allows better gliding of the joint.  This is a relatively new treatment for hallux rigidus and the results appear promising in the appropriate patient.