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Big Toe Arthritis- Hallux Rigidus

The most common site of arthritis in the foot is at the big toe or the metatarsophalangeal, or MTP joint. It’s important because it bends every time you take a step. If it stiffens, walking is painful and difficult.

In the MTP joint, the ends of the bones are covered by a smooth white articular cartilage. This surface has no nerves and therefore makes it ideal to rub agaist each other. Wear-and-tear /injury damages the articular cartilage. Raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. Stiffness prevents the toe from bending when you walk. The result is a stiff big toe, or hallux rigidus.

Hallux rigidus usually develops in adults between the ages of 30 and 60 years. No one knows why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.

Symptoms

Pain on motyion and when you push-off when you walk
Swelling around the joint
A bump, which is extra bone develops on the top of the foot
Stiffness in the great toe and an inability to bend it up or down develops

Diagnosis

Bending your toe up and down is difficult and you begin to walk on the outside of your foot because of pain in the toe. Hallux rigidus is easier to treat when the condition is caught early. If you wait until you see a bony bump on the top of your foot, the bone spurs will make the foot more difficult to treat..

Your doctor will examine your foot to look for evidence of bone spurs. He or she may move the toe around to see how much motion is possible without pain. X-rays will show the location and size of any bone spurs, as well as the degree of degeneration in the joint space and cartilage.

Above: This can be the view from the side / Xray shows a big spur of bone

Below: This is the view from the top

 

Treatment

Nonsurgical Treatment

Analgesia and shoes
Pain relievers and anti-inflammatory medications such as ibuprofen may help reduce the swelling and ease the pain. Applying ice packs may also help reduce inflammation and control symptoms for a short period of time. But they donot stop the condition from progressing. Wearing a shoe with a large toe box reduces the pressure on the toe, and you will probably have to give up wearing high heels. Your doctor may recommend that you get a stiff-soled shoe with a rocker design and possibly even a steel shank or metal brace in the sole. This type of shoe supports the foot when you walk and reduces the amount of bend in the big toe.

Joint Injections

Joint injections may provide reilef from pain. It is particularly useful wehen used with other modalitlies. It may work better in less severe arthritis and can give short/medium term relief of pain.

Surgical Treatment

Cheilectomy:  This surgery is recommended when damage is mild or moderate. It involves removing the bone spurs as well as a portion of the foot bone, so the toe has more room to bend. The incision is made on the top of the foot. The toe and the operative site may remain swollen for several months after the operation.  You may have to wear a special flat shoe for 2 weeks after the surgery. Most patients do experience long-term relief.

Arthrodesis: Fusing the bones together (arthrodesis) is recommended when the damage to the cartilage is severe. The damaged cartilage is removed and pins, screws, or a plate are used to fix the joint in a permanent position. The bones grow together and removes pain. After this type of surgery,  you will not be able to bend the toe at all. Most often this would have been limited by the arthritis anyhow.  You convert a painful stiff joint to a painless stiff joint . It is the most reliable way to reduce pain in severe cases.

For the first six weeks after surgery, you will have to wear a special shoe witha heel and you may need to wear a shoe with a rocker-type sole.

Arthroplasty (are-throw-plas’-tee) . Older patients who place few functional demands on the feet may be candidates for joint replacement surgery or bone excision.The joint surfaces are removed and an artificial joint is implanted or simply decompressed. This procedure may relieve pain and preserve joint motion.

Above: Fusion of the arthritic stiff joint using 2 screws