Arthritis in the Big Toe: Small Joint, Big Impact

By: Kelsie Mazur, DPT 

When most people think of arthritis they picture stiff knees or achy hands. But one of the most common and disruptive places to get arthritis is actually the big toe. More specifically, it’s the joint at the base of the toe, called the first MTP joint. This small joint plays a big role in how we walk, push off the ground, and stay balanced. When changes happen in this joint, they can lead to pain, stiffness, and difficulty with even simple daily activities. Recently, I’ve had 3 separate patients with this same issue, making it more common than I thought. 

Here’s the important thing: arthritis is not something to fear. It’s a completely normal and natural part of how our joints change over time. Almost all of us will experience some degree of arthritic change as we age. It's simply a matter of whether those changes create symptoms. Remember, just because we see changes on imaging doesn’t mean pain or dysfunction is guaranteed. And just because you’re feeling pain doesn’t mean you’re broken. There is so much we can do in physical therapy to help you move better and feel better.

There are different types of arthritis that can affect the big toe. The most common is osteoarthritis, the natural wear-and-repair process in the joint over time. There's also hallux rigidus, a form of arthritis that leads to stiffness and decreased range of motion. Certain factors can increase stress on the joint: repetitive activities like running or jumping, previous injuries to the toe or foot, and footwear that restricts natural toe movement. Age plays a role too, as the body naturally adapts and changes with time. But again, these changes are part of life, not something to panic over.

When someone comes to me with big toe pain, the first thing I do is look at how the joint is moving. I assess range of motion, tenderness, and how your body is compensating during walking or other movements. If I suspect arthritis or another condition may be playing a role, I may recommend following up with a physician for imaging. That allows us to work together to make sure you’re on the right track and not missing anything.

In physical therapy, we focus on improving how your body functions, not just what’s on a scan. Many people have joint changes and no pain at all. Others have discomfort but little change visible on imaging. That’s why we look at the whole picture: how you're moving, how your foot and body are working together, and how we can restore strength, mobility, and control.

When it comes to treatment, my approach is active and hands-on. I don’t use orthotics or rely on external supports that limit natural motion. Instead, I gently reintroduce movement to the joint using manual therapy techniques. This helps reduce stiffness, improve comfort, and restore better joint mechanics. Once motion improves, we begin building strength from the ground up. That includes the small muscles in your feet, your calves, hips, and core. We retrain the body to support movement in a more efficient and less painful way. This whole-body approach helps offload pressure from the joint and creates lasting change in how you move and feel.

Outside of sessions, I encourage consistent, thoughtful movement. Supportive shoes with a wide toe box can be helpful, especially avoiding overly stiff or narrow shoes. Gentle stretching, time barefoot on safe surfaces, and low-impact activities like walking or cycling can all support healing.

Bottom line: Arthritis doesn’t mean you’re broken and it doesn’t mean you need to stop moving. It’s a natural part of life that we all experience in some form. What matters most is how your body adapts and how we support it through that process. With the right approach, based on movement, strength, and restoring your natural capacity you can feel strong, capable, and confident in your body again.

Let’s chat! Book an assessment and let’s get you back to feeling good in your body.
No referrals, no waiting, just answers. Did you know that we offer free 1-on-1 injury screens? Wattage Physical Therapy will take an in depth look at your ergonomics, posture, muscle tone, muscle weaknesses, and movement patterns to create a plan for YOU. If this article intrigues you, you can directly email me, Kelsie at Kelsie@wattagept.com. I would be happy to help you start the process of living a life free from pain.