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Forefoot Arthritis

What is forefoot arthritis?

Big toe arthritis (hallux rigidus) is an arthritic condition of the big toe joint, leading to stiffness and pain.

Freiberg’s disease (Freiberg’s infarction) is a condition often affecting the second toe joint. While the cause is unknown, it often begins after trauma and can affect the blood supply to the bone, causing painful arthritis. It most often occurs in adolescent females.

What causes forefoot arthritis?

Big toe arthritis (hallux rigidus) is thought to be due to repetitive motion and stress across the big toe joint from walking, running, and athletic activities. This can progress gradually over years as the cartilage wears out on the top half of the joint. Over time, large bone spurs can develop which may be painful.

Freiberg’s disease (Freiberg’s infarction) is thought to be the result of trauma or repetitive overloading of the metatarsal causing disruption of the blood supply.

What are the symptoms of forefoot arthritis?

The symptoms of hallux rigidus include, pain, stiffness and swelling of the big toe joint. Hallux rigidus may also be associated with large bone spurs on the top of the big toe that are painful with shoe wear. The symptoms of Freiberg’s disease (Freiberg’s infarction) include pain and stiffness, most commonly of the second toe that worsens with activity.

How is forefoot arthritis diagnosed?

Forefoot arthritis is diagnosed with medical history, thorough physical examination and imaging studies. X-rays will be ordered to evaluate for any bony abnormalities such as joint space narrowing and bone spurs. An MRI may also be ordered.

How is forefoot arthritis treated?

Nonsurgical treatment

Forefoot arthritis may cause pain and stiffness that worsens with activity. It can be treated successfully with conservative measures. Rest, anti-inflammatory pain medications, immobilization in a walking boot, ice to decrease swelling, and activity restrictions are often prescribed. Physical therapy is used for strengthening, stretching and walking rehabilitation. Orthotics may also be helpful to relieve symptoms.


In more severe cases, surgery can be indicated to relieve pain.