Medically reviewed by Dr. Tom Biernacki, DPM — Board-Certified Podiatric Surgeon — Balance Foot & Ankle, Howell & Bloomfield Hills, MI. Last updated April 2026.

Hallux Rigidus Treatment Michigan

Hallux rigidus is arthritis of the first metatarsophalangeal (MTP) joint — the main big toe joint — causing progressive stiffness, pain, and bone spur formation. It is the most common arthritic condition of the foot, affecting approximately 1 in 40 adults over age 50. The name means “stiff big toe” in Latin. Dr. Tom Biernacki DPM at Balance Foot & Ankle provides comprehensive hallux rigidus treatment in Michigan at our Howell, Brighton, and Bloomfield Hills locations.

Hallux Rigidus vs. Hallux Limitus

Hallux limitus describes reduced (but not absent) big toe dorsiflexion — typically less than 50–60° of upward motion. Hallux rigidus is the advanced stage where range of motion is severely restricted or absent. Both cause similar symptoms of pain and functional limitation, but treatment options differ by stage.

Grading System

• Grade 0: Pain with stressful activities; no X-ray changes; normal range of motion
• Grade 1: Mild narrowing of joint space; small dorsal osteophyte (bone spur); mild restriction of motion
• Grade 2: Moderate joint space narrowing; prominent dorsal osteophyte; moderate restriction (20–50% loss)
• Grade 3: Severe joint space narrowing or obliteration; large osteophytes; marked stiffness; pain throughout range of motion
• Grade 4: Same as Grade 3 with additional stiffness of the plantar portion of the joint

Symptoms

• Pain and stiffness at the base of the big toe — worsened by walking, running, or squatting
• Difficulty pushing off during walking (antalgic “stiff-legged” gait)
• A visible and palpable bony bump on the top of the big toe joint
• Swelling around the first MTP joint
• Numbness or tingling on the top of the toe from dorsal nerve compression by the osteophyte

Treatment Options

Conservative treatment: Stiff-soled rocker-bottom shoes or a Morton’s extension orthotic (extending under the big toe) reduces first MTP joint motion during gait, alleviating pain in Grades 1–2. Activity modification, anti-inflammatory medications, and corticosteroid or viscosupplementation (hyaluronic acid) injections provide short-term pain relief.

Cheilectomy — surgical removal of the dorsal bone spurs — is the procedure of choice for Grade 1–2 hallux rigidus and for Grade 3 in active patients. Dr. Biernacki removes the osteophyte and up to 30% of the dorsal metatarsal head through a small dorsal incision, restoring 20–40° additional dorsiflexion. Patient satisfaction exceeds 90%; return to regular shoes at 4–6 weeks.

First MTP joint fusion (arthrodesis) is the gold standard for Grade 3–4 hallux rigidus. The joint surfaces are prepared and fixed in optimal position with screws and/or a plate, permanently eliminating pain. Patients walk immediately after surgery in a surgical shoe. Long-term function is excellent for all activities including hiking and golf.

Synthetic cartilage implant (Cartiva) is a motion-preserving alternative to fusion for Grade 3 — a polyvinyl alcohol hydrogel implant resurfacing the metatarsal head. Appropriate for selected patients who desire preserved motion.

Frequently Asked Questions

Schedule your hallux rigidus evaluation at Balance Foot & Ankle in Howell, Brighton, or Bloomfield Hills, Michigan.

Hallux Rigidus Treatment — Restore Big Toe Motion

Stiff, painful big toe joint doesn’t have to limit your life. Our podiatrists offer the full range of treatments from shoe modifications and injections to joint-sparing and replacement surgery.

Clinical References

1. Coughlin MJ, Shurnas PS. “Hallux rigidus: demographics, etiology, and radiographic assessment.” Foot Ankle Int. 2003;24(10):731-743.
2. Baumhauer JF. “Decision making for hallux rigidus.” Foot Ankle Int. 2011;32(9):909-911.
3. McNeil DS, et al. “Evidence-based analysis of treatments for hallux rigidus.” Foot Ankle Int. 2013;34(1):108-115.

Your Board-Certified Podiatrists

Dr. Tom Biernacki, DPM

Board-Certified · FACFAS

Dr. Carl Jay, DPM

Board-Certified Podiatrist

Dr. Daria Gutkin, DPM

Podiatrist

Dr. Tom Biernacki, DPM

Dr. Tom Biernacki, DPM is a double board-certified podiatrist and foot & ankle surgeon at Balance Foot & Ankle Specialists in Southeast Michigan. With over a decade of clinical experience, he specializes in heel pain, bunions, diabetic foot care, sports injuries, and minimally invasive surgery. Dr. Biernacki is a member of the APMA and ACFAS, and his patient education content on MichiganFootDoctors.com and YouTube has reached over one million views.