What is it?
Arthritis is a condition that occurs when the cartilage that covers both sides of a joint deteriorates and the joint space narrows. Arthritis of the big toe can cause disabling pain, limited motion, and loss of the normal function of the foot when walking. This can make shoe selection difficult and limit your desired activity level. Arthritis in the big toe joint can be caused by degenerative arthritis, rheumatoid arthritis, or an associated bunion deformity. When there is a limited range of motion at the joint the condition is termed hallux limitus (hallux is the Latin word for the great toe). If the joint damage has progressed and there is little to no motion remaining in the joint, the condition is called hallux rigidus and you may have pain in the joint even when at rest.
Diagnosis
Most cases can be diagnosed based on the clinical history and physical examination alone. However, X-rays are extremely important and help understand the extent of arthritis, the size, and the location of the bone spurs.
Figure 1. Figure 2.
Figure 1. Arthritis of the big toe joint. The white arrow points to a chip fracture of the base of the big toe. The red arrows identify joint space narrowing and degeneration of the metatarsal head.
Figure 2. Side view of the big toe joint outlined in yellow with red arrows pointing to a large spur of the metatarsal head which causes jamming of the joint when the toe flexes upward.
Treatment Options
During an acute flare of arthritis, ice, oral anti-inflammatories or steroid injections (in limited number) can aid in symptom relief but will not cure the joint damage or prevent it from worsening. Conservative treatment of a painful arthritic big toe joint is focused on either promoting normal joint alignment with padding and orthotics or limiting joint motion with the use of a carbon fiber footplate. Some patients find wearing a rocker bottom sneaker can be very beneficial as well. This is dependent on your available range of motion and if you have a functional or structural deformity determined on examination. Avoid walking barefoot or in flimsy flip flops or sandals.
If conservative treatment has failed to provide pain relief and the condition is preventing you from performing normal activities of daily living, a surgical procedure may be indicated. The goal of surgery is to decrease your pain level. There are many surgical options available.
- If arthritis in the joint is mild to moderate, you may be a candidate for a simple resection of spurs which requires very little recovery time but may only provide temporary relief.
- If the arthritis is moderate, the joint space can be increased by a procedure similar to a bunionectomy, in which the metatarsal head is moved into better alignment by cutting the bone and fixating it in a new position with screws. Alternatively, the joint can be partially replaced with an implant as seen in Figure 3. This procedure does not require the metatarsal head to be repositioned.
- If the arthritis is severe and the degeneration has advanced to the point at which the joint is not salvageable, a fusion may be indicated. This is a procedure in which the cartilage is completely removed from both sides of the joint and the bones are fused together, eliminating all motion. While this will help alleviate a painful joint, activities that require movement in the toe joint, such as running, yoga, lunges, or wearing high heels will not be possible.
Figure 3 – Before Figure 3 – After
Figure 3. Before and after pictures following hemi-implant arthroplasty in which the base of the great toe joint is removed and replaced with an implant.
Talk to a Podiatrist
There are many non-surgical, and surgical options available to help provide you with adequate pain relief that will help keep you active. If you are suffering from arthritis in your great toe joint, schedule an appointment today with Dr. Ariel Lepoff at The Medical Group of South Florida to explore your options.
Dr. Lepoff’s services include bunions, hammertoes, heel pain, tendonitis, warts, calluses, sports injuries, foot and ankle fractures, ingrown toenails, wound care, neuromas, diabetic foot care, and so much more!