Hyaluronic Acid Joint Lubrication for Big Toe Arthritis
Big toe arthritis doesn’t always mean it’s time for surgery.
Pain, stiffness, or a grinding sensation at the base of the big toe can make something as simple as walking, exercising, or wearing your favorite shoes increasingly difficult. This condition, known as hallux rigidus, is arthritis of the first metatarsophalangeal joint—the joint where the big toe meets the foot. It is also a common source of what patients describe as bunion pain.
At Millennium Podiatry on Manhattan’s Upper East Side, our goal is to preserve comfortable movement whenever possible. For appropriately selected patients, we offer the Loub Job—our name for hyaluronic acid joint lubrication of the big toe joint, also known as viscosupplementation.
The concept behind the Loub Job is straightforward: improve lubrication within the arthritic joint space, reduce symptoms, and potentially help patients stay active while postponing more invasive treatment when clinically appropriate.
The first metatarsophalangeal joint plays an important role every time you take a step. As your body moves forward, the big toe must bend upward so that you can push off the ground.
With hallux rigidus, the cartilage covering the joint surfaces gradually deteriorates. This can lead to:
As arthritis progresses, the joint may become increasingly stiff and painful. Related stiffness is also described as hallux limitus or big toe arthritis.
Healthy joints contain synovial fluid, which helps the opposing joint surfaces move smoothly against one another.
Hyaluronic acid is a naturally occurring component of connective tissues and joint fluid. Injectable hyaluronic-acid products are designed to act as viscoelastic joint supplements, which is why this form of treatment is commonly referred to as viscosupplementation.
An arthritic joint can lose some of the smooth lubrication that allows comfortable motion. Hyaluronic acid is used with the goal of improving lubrication within that joint space.
The Loub Job is Millennium Podiatry’s name for a hyaluronic acid injection delivered directly into the affected big toe joint.
Rather than simply numbing the area, the Loub Job uses viscosupplementation with the goal of improving lubrication within the joint space.
For someone with big toe arthritis, the goals may include:
Less pain • Smoother motion • Improved comfort while walking • Greater tolerance of activity • Maintaining joint function • Potentially postponing surgery
It is important to understand that hyaluronic acid does not regrow worn-away cartilage or reverse advanced arthritis.
Instead, we use it as part of a joint-preservation strategy designed to improve symptoms and maintain function for as long as reasonably possible.
There is clinical research evaluating hyaluronic acid injections specifically for arthritis of the big toe joint.
One clinical study comparing sodium hyaluronate with a corticosteroid injection found that both groups experienced improvement, while walking-related pain showed greater improvement with hyaluronate at certain short-term follow-up points.
Other research, however, has produced more mixed results. A randomized placebo-controlled trial involving symptomatic first MTP joint osteoarthritis found that a single hylan G-F 20 injection was not superior to placebo for reducing symptoms.
A 2024 systematic review concluded that hyaluronic acid injections for hallux rigidus may improve clinical outcomes with a relatively low complication rate in the short term, while emphasizing that the overall quality of the available evidence remains limited.
A 2022 pilot study also reported encouraging results, particularly among patients with mild-to-moderate first MTP joint osteoarthritis, although larger randomized trials are still needed.
What does that mean for our patients?
It means the Loub Job, using hyaluronic acid viscosupplementation, can be a reasonable option to discuss for selected patients—but it should not be presented as a guaranteed treatment.
At Millennium Podiatry, we look at the entire clinical picture, including:
For many patients with big toe arthritis, the real question is not:
“Can I make the arthritis disappear?”
It is:
“Can I keep this joint comfortable and functional without having surgery right now?”
That is where joint-preservation treatments may become valuable.
If an injection reduces pain and allows a patient to walk, exercise, travel, or wear shoes more comfortably, it may provide an additional period of successful nonsurgical management before an operation needs to be considered.
However, hyaluronic acid has not been proven to stop the structural progression of hallux rigidus or definitively delay surgery. Its role is primarily symptom management and preservation of comfortable function in appropriately selected patients.
At Millennium Podiatry, we view the Loub Job as one potential tool within a larger joint longevity strategy. Custom orthotics and footwear changes may also be part of that plan.
Surgery can be the right choice for some patients with advanced arthritis or severe deformity. It is not automatically the first step for every person with a painful big toe.
Joint-preservation care may include activity modification, shoe changes, custom orthotics, anti-inflammatory treatment, and, when appropriate, viscosupplementation with the Loub Job.
The goal is to keep the joint as comfortable and functional as possible for as long as that remains a realistic option.
Cortisone can reduce inflammation quickly. Hyaluronic acid is used differently: the intent is to supplement lubrication inside the joint rather than simply suppress inflammation.
Some patients have already tried a steroid injection. Others prefer to discuss a non-steroid option first. The right sequence depends on the joint, the imaging, and the patient’s goals—not on a single preferred product.
A candidate is typically someone with symptomatic big toe arthritis or hallux rigidus who still has usable joint motion and whose priority is staying active without rushing to surgery.
It is less likely to be sufficient as a standalone plan when the joint is fused, severely collapsed, or already planned for reconstructive surgery.
Pain at the base of the big toe is not always arthritis alone. Bunion deformity, sesamoid irritation, gout, and other conditions can overlap. An examination and, when needed, imaging help confirm that the first MTP joint is the pain generator before an injection is recommended.
Injectable hyaluronic-acid products have FDA-approved orthopedic indications in other joints. Use in the big toe joint may be off-label depending on the specific product. That should be reviewed with your physician before treatment.
The Loub Job is one option inside a broader plan. Footwear, activity load, custom orthotics, and—when needed—surgical discussion all belong in the same conversation.
If big toe pain, stiffness, or bunion discomfort is changing how you walk or which shoes you can wear, we can evaluate whether hyaluronic acid joint lubrication is appropriate for you at our Park Avenue office.
Medical disclaimer: This content is for general educational purposes and is not a substitute for an individualized medical examination, diagnosis, or treatment plan.
About the Author
Dr. Suzanne Levine
Named one of America’s Top Podiatrists and is one of the most internationally acclaimed podiatrists in the industry.
August 19, 2026
