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Big Toe Arthritis

Arizona Orthopedic Surgery Solutions for Big Toe Arthritis

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Table of Contents - Big Toe Arthritis

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What is Big Toe Arthritis

Hallux rigidus, more commonly known as big toe arthritis, is when there is arthritis at the base joint of the large toe. Aside from ankle osteoarthritis, big toe arthritis is one of the most usual forms of arthritis afflicting folks over fifty, with developing cases in those over thirty. The hallux metatarsal phalangeal (MTP) joint, or big toe joint, connects the metatarsal, or first foot bone, with the proximal phalanx, or first toe bone and sesamoids, or two tiny bones below the metatarsal. The top of the joint is the most common location for osteoarthritis, or “wear-and-tear.”

Big Toe Arthritis Diagnosis

Inflammation and limited range of motion, specifically pain when moving and bending the large toe are normal. Most commonly, complaints when “pushing off” while stepping are noted. Sometimes, a bone spur will develop atop the big toe joint and become agitated by the friction caused by the top of a shoe. A long or raised first foot bone, previous injury to the big toe, and family history can all account for big toe arthritis. These three conditions cause wear and tear to the joint which starts the onset of arthritis. A doctor will ask about your medical history before examining the range of motion and location of the pain. Furthermore, the doctor will check for bone spurs too. X-rays can be used to see the level of joint damage, location of bone spur(s), and size of bone spur(s). MRI and CT scans are not normally necessary.

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Big Toe Arthritis Treatment - Nonsurgical

A doctor will always recommend over-the-counter pain relievers and nonsteroidal anti-inflammatories with the assistance of heat and ice packs to alleviate pain. Injections are usually withheld, as platelet-rich plasma and other injections efficacy vary. It is best to wear shoes with thick, supportive soles with plenty of space for your toes. High-heeled shoes that pinch your toes should not be worn. Consider purchasing heel gels, supportive insoles, or orthotics to increase arch support and immobilizes big toe joint motion. Nonsurgical treatment can only manage symptoms and pain, but the continuation of the condition cannot be stopped.

Big Toe Arthritis Treatment - Surgical

In mild and moderate cases, bone spur removal surgery, or cheilectomy, can be performed. Removing the bone spur and part of the bone atop the foot and big toe allows the toe to bend and alleviates “push off” pain when walking. Motion and balance are kept alongside preservation of the joint itself, which is a perk of a cheilectomy. Joint fusion surgery, or arthrodesis, is saved for late phases of big toe arthritis. This where the joint cartilage is taken out and two or more bones are held together with screws and plates to become one bone. While the pain is subdued, there is a loss of motion range in the big toe despite the majority of patients keeping the ability to be active. Joint resurfacing surgery, or interpositional arthroplasty, is used for moderate to extreme big toe arthritis for patients who wish to maintain their range of motion. Like cheilectomy, damaged bone is taken out and a spacer is used to keep the two bones from sliding on both sides of the joint. Soft tissue can be grafted from another place in your body or from a cadaver and used as a means to try to resurface the joint. Otherwise, synthetic cartilage comprised of polyvinyl alcohol can be used as the spacer. Less bone is taken out with an easier ability to perform arthrodesis should the procedure fail. Should less intrusive surgeries fail or significant bone and cartilage damage be apparent, joint replacement surgery, or arthroplasty will be necessary. Arthroplasty has had great success for larger joints such as the knee, hip, and ankle, but with elevated complication rates, erratic short term and long term outcomes, and challenges with recovery surgeries in the event the joint replacement disappoints, surgeons normally look to other procedures as a first option with big toe joint arthritis.

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