Foot osteoarthritis concentrates in three sites: the base of the big toe, the joints of the midfoot, and the ankle. The first effective measure is not a drug but a stiff soled shoe, which stops the painful joint bending at every step.
The point almost no British page makes: in hallux rigidus it is the degree of movement left in the toe, not the intensity of the pain, that steers the treatment decisions.
Three sites, and how to recognise them
Where foot osteoarthritis actually settles
sites
Base of the big toe
The first metatarsophalangeal joint, by far the most commonly affected. Stiffness and pain pushing off, worse in flexible shoes. Known as hallux rigidus.
Midfoot, across the top
The small joints between the tarsal bones and the metatarsals. Aching on the instep, worse standing for long periods, sometimes with a palpable bony ridge.
Ankle and below it
Uncommon as primary osteoarthritis. In British practice it is nearly always the late consequence of an old fracture or repeated sprains.
The foot has more than thirty joints, but osteoarthritis does not scatter itself among them. It concentrates where the load per square millimetre is highest and where movement is most repeated, and in practice almost every case falls into one of the three categories above.
of adults aged 50 and over have symptomatic osteoarthritis of the foot, meaning pain and radiographic changes at the same site. The joint at the base of the big toe is the most frequently affected.
Clinical Assessment Study of the Foot, Keele University, North Staffordshire
That figure comes from a large community study run from Keele University in North Staffordshire, which examined and X-rayed adults over 50 in the general population rather than in a clinic. Foot osteoarthritis is not a rarity, and it is substantially under-recognised compared with the knee and the hip.
Hallux rigidus, the commonest form
The joint at the base of the big toe takes a force greater than body weight at every step. It has to bend upwards by roughly sixty degrees for the foot to leave the ground normally, and that is the movement osteoarthritis takes away first.
Pain appears in the push off phase of the step, going upstairs, squatting, and characteristically in flexible shoes that force the toe to bend. A bony ridge often develops on the top of the joint, which then catches on the shoe.
Test it yourself sitting down: pull the big toe upwards with your hand and compare it with the other foot. Over sixty degrees and the joint is working. Under thirty and you are into the range where surgery gets discussed. That measurement is what a foot and ankle surgeon looks at first, and you can arrive with it already done.
Midfoot osteoarthritis
Less well known, this affects the small joints between the tarsal bones and the metatarsals, in the middle of the foot. The pain sits on the instep, on top of the foot, and worsens with prolonged standing or walking on uneven ground.
The clue is a palpable bony ridge on the top of the foot, often sore where the shoe laces press. Some people discover it because tying their laces became painful at one precise spot. Pain that follows the line of the laces without a bony ridge under it is usually the extensor tendons being compressed, and relacing around the sore point settles it. Which of the four foot tendons is involved, and where each of them hurts, is set out separately.
The ankle is a different story
Primary osteoarthritis of the ankle is uncommon. Unlike the hip and knee, where it frequently develops with no identifiable cause, the ankle wears out mainly after a fracture, a severe sprain or repeated sprains. That also explains why it affects younger people, and why the history matters so much.
| Site | When it hurts | First thing that helps |
|---|---|---|
| Big toe joint | Pushing off, stairs, squatting down | Stiff sole with a rocker under the forefoot |
| Midfoot | Standing a long time, uneven ground | Supportive insole plus a stiff sole |
| Ankle | Longer distances, walking downhill | Higher cut shoe or brace, balance work |
| Joint below the ankle | Rough ground, walking sideways across a slope | Insole that limits twisting |
Who gets it, and why
The risk factors identified in community studies are consistent, and there is nothing exotic among them. Older age is the strongest. Women are affected more often than men, and the gap widens after the age of sixty. Excess body weight raises the load through every joint in the foot at every step, and it also carries a metabolic effect on cartilage that is independent of the mechanical one.
Previous injury matters more in the foot than almost anywhere else. A fracture, a badly sprained ankle, or years of a joint being loaded abnormally after an old injury all shorten the road to osteoarthritis at that site.
Occupation counts too. Jobs involving prolonged standing, walking on hard surfaces, or repeated squatting are over-represented, and people in those roles often find joint pain appears in their fifties rather than their seventies.
Foot posture is the factor most often blamed and the one with the least clear evidence. Flat feet and high arches both change how load distributes, but the relationship with osteoarthritis is weaker than popular health writing suggests, and it is not a reason to buy expensive corrective insoles on spec.
What none of these change is the management. However the condition arrived, and whatever the X-ray shows, the treatment sequence stays the same: the shoe, the insole, the exercise, then medication. That ordering, the mechanical change before the tablet, is the one that also governs osteoarthritis in the hand. Being able to name the cause is satisfying and it does not alter what you do on Monday.
What British podiatry actually does
The Royal College of Podiatry lists osteoarthritis among the common foot problems it treats, and podiatry is the service that changes the mechanics. Access varies: NHS podiatry is available in most areas but is often prioritised towards higher risk feet, particularly in diabetes, so waits differ considerably by region.
What a podiatrist changes, in order: the shoe, then an insole, then the way you load the foot. A rigid rocker sole for the big toe joint, a supportive insole for the midfoot, and advice on distance, surface and activity. That sequence is unglamorous and it produces most of the benefit. It is the same logic as a night splint at the base of an arthritic thumb: change what the joint is asked to do before changing what you swallow.
Medication sits alongside it rather than instead of it. A worn joint carries a genuine low-grade inflammatory component rather than being pure mechanical wear, which is why an anti-inflammatory approach has a rationale here at all. NICE recommends tailored therapeutic exercise for everyone with osteoarthritis before any drug, then a topical anti-inflammatory, and it advises against offering glucosamine. If you are adding a supplement, judge a bioavailable anti-inflammatory formula on how much of the active compound is absorbed, and treat anything sold for worn joints as an addition to the footwear change. The shoe still has the larger effect.
When to see a GP or a podiatrist
- Pain that came on suddenly after an injury, with an inability to bear weight.
- A deformity that is changing quickly over weeks rather than years.
- Night pain at rest, with no weight going through the foot at all.
- Diabetes, which makes any foot pain, callus or skin break worth prompt attention.
- Pins and needles or numbness in the sole, which points to a nerve rather than a joint.
Frequently asked questions
What does osteoarthritis in the foot feel like?
An ache that comes on while you are walking and settles with rest, stiffness first thing in the morning or after sitting a long time, and gradually less movement in the affected joint. Bony ridges may appear on the top of the foot or at the base of the big toe. The pain is mechanical: worse with use, not at night while resting.
What are the symptoms of arthritis in the foot?
Pain in a specific joint rather than across the whole foot, stiffness that eases with movement, swelling that comes and goes, and a joint that grinds or catches. Shoes that used to be comfortable start rubbing over a new bony prominence. Many people notice first that they can no longer squat down or that going upstairs has changed.
Can anything be done for osteoarthritis in the foot?
A great deal, and most of it is not medication. A shoe with a rigid sole and a slight rocker under the forefoot stops the painful joint bending at every step and is the single most effective first measure. Add a supportive insole where the midfoot is involved, keep the foot moving with low impact activity, and use topical anti-inflammatories during bad spells.
Is exercise good for arthritis in the feet?
Yes, and stopping walking makes things worse. Immobility stiffens joints, weakens the small muscles of the foot and reduces tolerance to load. What needs adapting is how: suitable shoes, even surfaces, distance built up gradually, and low impact options such as cycling or swimming alternated in. NICE puts tailored exercise ahead of every drug for osteoarthritis at any site.
What is hallux rigidus?
Osteoarthritis of the joint at the base of the big toe, and the commonest form of foot osteoarthritis. It causes pain and a progressive loss of the ability to bend the toe upwards, the movement you need at the end of every step. It is not the same as hallux valgus, which is a sideways drift of the toe, although the two can coexist.
What shoes should I wear with foot osteoarthritis?
A shoe whose sole does not bend easily when you twist it in your hands, with a slight curve under the forefoot to help you roll through the step. You want width and depth for the toes, and a low but not flat heel, one or two centimetres. Very flexible running shoes, often bought for comfort, are among the worst choices here.
Do I need surgery for foot osteoarthritis?
Most people never do. Surgery is discussed when pain remains disabling despite footwear changes, insoles, exercise and medication properly tried over months. Fusing the big toe joint reliably removes pain at the cost of movement, and in the randomised evidence on painful big toe deformity, surgery gave better pain outcomes at a year than an orthosis or waiting.
What to take away
Pick up the shoes you wore today and try to fold them in half. If they bend easily under the forefoot, they are probably part of the problem, whichever of the three sites is affected.
Then, if the pain is at the base of the big toe, measure how far you can pull it upwards compared with the other foot. That number is the first thing a surgeon will look for, and you can walk in with it.
Sources
Roddy E., Menz H.B. (2018). Foot osteoarthritis: latest evidence and developments. Therapeutic Advances in Musculoskeletal Disease, 10(4), 91-103. DOI: 10.1177/1759720X17753337
Robinson W.H., Lepus C.M., Wang Q. et al. (2016). Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis. Nature Reviews Rheumatology, 12(10), 580-592. DOI: 10.1038/nrrheum.2016.136
Sanchez-Lopez E., Coras R., Torres A. et al. (2022). Synovial inflammation in osteoarthritis progression. Nature Reviews Rheumatology, 18(5), 258-275. DOI: 10.1038/s41584-022-00749-9
Torkki M., Malmivaara A., Seitsalo S. et al. (2001). Surgery vs orthosis vs watchful waiting for hallux valgus: a randomized controlled trial. JAMA, 285(19), 2474-2480. DOI: 10.1001/jama.285.19.2474
Musorrofiti M.G., Bonifacio M., Cipolloni V. et al. (2026). The use of physical energy-based therapies in the management of osteoarthritis. Medicina, 62(6), 1119. DOI: 10.3390/medicina62061119
