What are the treatment options for hallux limitus (osteoarthritis of the first metatarsophalangeal joint)?

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Last updated: April 21, 2025 • View editorial policy

From the Research

Treatment for great toe osteoarthritis should begin with conservative approaches, prioritizing pain management and functional preservation, as there is moderate-certainty evidence that non-surgical treatments such as arch-contouring foot orthoses, shoe-stiffening inserts, and intra-articular injection of hyaluronic acid show little to no difference in pain, function, or quality of life compared to placebo or sham treatments 1.

Conservative Management

  • Start with over-the-counter pain medications like acetaminophen (500-1000mg every 6 hours, not exceeding 4000mg daily) or NSAIDs such as ibuprofen (400-800mg three times daily with food) or naproxen (220-500mg twice daily), considering the safety profile and potential gastrointestinal, cardiovascular, and renal risks associated with NSAIDs 2, 3.
  • Wear shoes with a wide toe box, low heels, and stiff soles to reduce toe movement; consider rocker-bottom shoes that decrease toe flexion during walking.
  • Custom orthotics with a Morton's extension can help limit toe motion.
  • Physical therapy focusing on toe and foot stretching exercises can maintain mobility.
  • Ice the joint for 15-20 minutes several times daily to reduce inflammation, especially after activity.

Additional Considerations

  • For more severe pain, your doctor may recommend corticosteroid injections into the joint, though these provide only temporary relief.
  • Weight loss can significantly reduce pressure on the toe joint if you're overweight.
  • If conservative treatments fail after 3-6 months, surgical options include cheilectomy (bone spur removal), joint fusion (arthrodesis), or joint replacement (arthroplasty), aiming to reduce pain by either preserving some motion or eliminating painful movement in the affected joint.
  • Recent studies and reviews emphasize the importance of understanding the mechanisms of action of different analgesics and their efficacy and safety in the context of osteoarthritis pain management 4, 5.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.