Julian Varney, Senior Podiatrist, Footprints Podiatry, Burnie & Ulverstone
Over the next three weeks there’s a bit of a triple-header for feet. World Arthritis Day lands on Monday 12 October, which is also the first day of Podiatry Week (12-18 October), and the Burnie Ten is on Sunday 25 October.
This year’s Podiatry Week theme, from the Australian Podiatry Association, is “Your feet do more than you think. So do podiatrists.” There’s no better example than the humble big toe.
What your big toe is actually doing
Every step you take, your big toe has to bend upwards so your foot can roll forward and push off. The joint at the base of it (the first metatarsophalangeal joint, or “1st MTP joint” if you want to sound fancy) does that thousands of times a day. Walking the dog along the foreshore, running 10 kilometres, pedalling, hauling a pack up a bushwalking track: all of it relies on that one joint bending freely and comfortably.
When it stops doing that, you notice. Quickly.
The windlass: how your big toe firms up your arch
There’s a neat bit of engineering hiding in that movement. Along the sole of your foot, a thick band called the plantar fascia runs from your heel to the base of your toes. When your big toe bends upwards as you push off, it pulls that band tight, a bit like winding a winch (the old-fashioned word is a “windlass”). The arch lifts and firms up, and your foot turns from a flexible, adaptable structure into a stiff lever you can push off from.
Podiatrists call the big toe and the long bone behind it the “first ray”, so you’ll hear this called the first ray windlass. You can see it for yourself: stand barefoot, keep the ball of your foot flat on the floor, and lift just your big toe. Watch your arch rise.
The catch is that the windlass only works if the big toe can actually bend. If it can’t, the arch doesn’t firm up as well, and other parts of the foot can end up working harder to make up for it.
When the joint gets stiff and sore
Big toe joint stiffness sits on a spectrum, and the names are simpler than they sound.
Hallux limitus means the big toe joint has lost some of its upward bend. “Limitus” is just “limited”. It’s often the earlier stage, and the joint can still move quite a bit, though it may be sore when you push off.
Hallux rigidus is further along. The joint is stiff (“rigid”), usually with wear in the cartilage and bony spurs around the joint. That’s the bony lump many people notice on top of the toe, and it’s essentially arthritis of the big toe joint. It’s one of the most common forms of arthritis in the foot, it can run in families, and an old injury (a jarred or stubbed toe, or years of impact sport) can contribute.
It’s the same problem at different stages, and it’s why we like to catch it and manage it early.
Functional hallux limitus: the sneaky one
Sometimes the big toe joint looks and moves perfectly well when we test it on the treatment couch with your foot in the air, but jams up when you’re standing and walking on it. That’s called functional hallux limitus.
It’s less about a worn-out joint and more about how the foot is moving. As you roll forward, the first long bone of the foot needs to drop down towards the ground so the big toe has room to bend upwards. If that bone can’t drop, the toe has nowhere to go. The windlass can’t wind up properly, the arch doesn’t firm up for push-off, and the load can end up somewhere else, such as under the ball of the foot, through the arch or heel, or up into the calf and shin.
Because the problem shows up in how the whole foot works, the clues are often away from the big toe joint itself. Common ones include:
- A callus on the inside edge of the big toe, often around the tip joint, where the toe twists and drags as you push off
- Callus or soreness under the ball of the foot, especially under the second and third toes, with little or no load going through the big toe’s own joint
- The tip joint of the big toe bending backwards (hyperextending) to make up for the base joint that won’t bend
- A bunion that’s creeping along, or toes that start to look clawed or hammered
- Pain in the heel or arch (including plantar fasciitis) or in the Achilles tendon
- Pain between the toes, sometimes diagnosed as a neuroma
- Shin or inner ankle pain, including posterior tibial tendon trouble
Any one of these has plenty of other possible causes, so none of them proves anything on its own. But a pattern of them, especially with a big toe joint that doesn’t look arthritic, is a clue worth following up.
X-rays of the joint often look normal, which is why we test the toe with weight going through the foot rather than only on the couch. It’s also an area where the research is smaller and less settled than for arthritic big toes, but many podiatrists find it a useful way to understand pain that doesn’t have an obvious cause.
The usual signs
- Stiffness, especially first thing in the morning or on a cold day (hello, Tasmanian winter)
- Pain when you push off: going uphill, running, or rising up onto your toes
- A bony lump on top of the joint that rubs on your shoes
- Aching or swelling after activity
- Walking on the outside of your foot to avoid bending the toe
Not every sore big toe is one of the above. Gout, a bunion, a sprained joint (“turf toe”) and problems with the little bones under the joint can feel similar, and the best treatment is different for each. That’s the main reason to get it looked at rather than guess.
A few myths worth clearing up
“It’s just getting older, I’ll have to live with it.” Joint changes are common as we age, but pain that’s changing how you walk, exercise or play with your kids isn’t something you just have to put up with. There’s usually a fair bit we can do.
“Keep it moving by going barefoot or wearing thongs.” Very flexible footwear asks the big toe joint to bend more with every step, which is the opposite of what an irritated joint wants. Many people are more comfortable in shoes that do some of the work for the toe.
“Toe arthritis always ends in surgery.” It doesn’t. Plenty of people manage well without it. Surgery is generally kept for people who have given the simpler options a fair go and are still being held back from the things they love.
“There’s a remedy for that.” Magnet insoles, copper, vinegar soaks and “detox” foot pads have no good evidence behind them for a worn joint. We’d rather save you the money and spend it on something that has a chance of helping.
What actually helps
What’s right for you depends on how irritable the joint is, how much movement it has left, and what you need your feet to do. Roughly in order:
Shoes first. The simplest way to take work off a stiff big toe is a shoe that does some of the bending for it. A rocker sole is curved from heel to toe, like the base of a rocking chair, so your foot rolls forward without needing as much bend at the big toe joint. Combine that with a stiffer sole and enough room across the toes (so the bony lump isn’t rubbing) and plenty of people find walking and running a lot more comfortable.
Cushioned rocker-style shoes are easy enough to find. Widely available ones include the Hoka Bondi and Clifton, Brooks Glycerin Max and Ghost Max, Saucony Hurricane and Triumph, On Cloudmonster, New Balance Fresh Foam X More, Mizuno Wave Sky and Asics GlideRide, plus two that we carry in our clinics: the Altra Olympus and the Topo Specter. Full disclosure, we carry Altra and Topo, but any of these may suit, and the right one depends on your foot.
Rocker shapes and sole stiffness vary a lot between shoes, and between versions of the same shoe, so it pays to try a few. A quick test in the shop: hold the shoe at the heel and toe and try to bend it. The stiffer it is, the less your big toe joint has to do. Rockers also feel different underfoot, and zero-drop shoes like the Altra feel different again around the heel and calf, so ease in rather than going straight to long runs. And this is also why a lot of people with a stiff big toe find stiff-soled cycling shoes or walking boots comfortable even when running is sore.
We now have an Aetrex Albert Pro scanner in both of our clinics, which measures the length, width and arch height of each foot (and more) quickly and accurately, and gives you a correct fitting match from a huge database of shoes, so you start from the right size.
Insoles and orthoses. Some designs, such as a stiffening plate under the big toe joint, can ease pain and change how the joint is loaded. For functional hallux limitus, one approach is a small cut-out or relief under the first long bone so it can drop down and the toe can bend. The research on orthoses is mixed. A 2026 review for hallux rigidus described them as moderately effective, with pain relief more consistent than improvements in function. So we use them where they make sense, start with the simplest option that does the job, and don’t oversell them.
Activity tweaks and exercise. Staying active matters, but it may need to look different for a while: more cycling or swimming, shorter hills, more rest between runs. Mobility and strengthening work are commonly used too, though the evidence for them in toe arthritis is thinner than we’d like.
Medication and injections. Your GP or pharmacist can help with short-term pain relief, and injections into the joint can help some people. Recent research suggests the relief is often temporary, with benefit lasting up to about 12 months in around half of cases.
Surgery. If you’ve tried the above and the joint is still stopping you doing what you want, it can be worth a conversation about referral to a specialist foot and ankle surgeon. Options range from cleaning up the joint to fusing it. If that’s where you land, we’ll refer you on.
Running the Burnie Ten?
A few things for the next three weeks
The Burnie Ten is on Sunday 25 October: the 10km starts at 10:00am, the 5km at 10:20am, and the kids’ 800m dash at 11:40am. We’re entering a Footprints Podiatry team this year, so give us a wave if you see us out there.
- Sort your shoes now. If yours are worn out, three weeks out is the time to replace them, so you’ve had a couple of weeks of runs in them before race day. If you’re trying a rocker-soled shoe for a stiff toe, give yourself time to adapt. Nothing new on race morning: same shoes, same socks, same laces. If you do need a new pair, Asics are on sale in our clinics while stocks last. We’re phasing that brand out to concentrate on niche brands you can’t get from other local retailers.
- Check there’s room. A thumb’s width in front of your longest toe, and no rubbing across the toes or over a bony big toe joint. Not sure of your size? Our Aetrex Albert Pro scanner measures each foot quickly and accurately. If you’re after a roomier toe box, we carry Topo and Altra.
- Look after your toenails. Trim them short and straight a few days before the race. Long nails and long runs are a bad mix.
- If something’s niggling, don’t push through. A big toe joint that’s sore during or after runs is worth getting checked before race day rather than after.
Podiatry Week: what do podiatrists actually do?
Podiatrists are registered, university-qualified health professionals with a broad scope of practice: sports injuries and biomechanics, diabetes-related foot care, children’s growing feet, arthritis, nail and skin conditions, and mobility in older age. It’s a lot more than “just nails and corns”.
According to the Australian Podiatry Association’s Australian Foot Health Survey, more than half of Australians surveyed had experienced ongoing lower-limb pain that affected their daily life, cutting into walking, exercise and the ability to stay active. If something’s been niggling longer than it should, now’s a good time to get it looked at.
Book an appointment at our Burnie clinic (127a Wilson Street) or Ulverstone clinic (56 Alexandra Street): book online
#PodiatryWeek2026
This article is general information only and isn’t a substitute for an individual assessment.
Further reading
- Australian Podiatry Association: Podiatry Week
- Burnie Ten: event information
- Musculoskeletal Health Australia: World Arthritis Day