Big Toe Joint Arthritis

Big toe joint arthritis is also known as hallux limitus or hallux rigidus.  This is a common painful foot condition that is frequently seen by doctors.

What is the difference between hallux rigidus and hallux limitus? 

Hallux limitus is when a patient feels pain and has limited range of motion at the great toe joint.  The pain and limited range of motion is due to the narrowing of the joint space and also development of arthritic bone around the joint.  The combination of the two creates pain and swelling when walking or performing weight bearing activities.

big toe joint arthritisHallux rigidus is the more serious condition of the two, because the big toe joint arthritis becomes so severe that the toe will no longer move and remains in a fixed position.  When this occurs the toe joint cannot move because of the severe arthritis and pain is increased due to the joint rubbing against the shoe.

How do you develop big toe joint arthritis?

There are many causes of big toe joint arthritis.  If the bones that make up the great toe joint are either too long or too short, it causes jamming of the joint and this will eventually lead to extra bone formation and limited motion of the joint.  Trauma to the great toe, whether it be stubbing the toe, dropping an object on the toe, or even repetitive motions will result in arthritis of the joint.  The trauma to the toe causes damage to the cartilage of the joint and results in subsequent swelling.  This change in the cartilage can result in loss of mobility and pain when performing activities.  Other causes can be related to metabolic diseases such as gout, rheumatoid arthritis, osteoarthritis, and infection.

What are the conservative options to treat big toe joint arthritis?

Initially if the symptoms are not severe then anti-inflammatory drugs can be utilized to help decrease pain and swelling to the area.  This is usually combined with a device that limits the great toe from moving. 

A custom orthotic can help to keep the great toe joint properly aligned to limit excessive abnormal motion of the joint.  This will relieve big toe joint arthritis.

Podiatrists will often add a rigid shank underneath the great toe that attaches to the custom orthotic in order to limit motion at the joint.  Corticosteroid injections to the great toe joint will also help to alleviate pain and swelling in the area associated with big toe joint arthritis.  Padding to the joint will help to decrease pressure from the shoe when walking.

What are the surgical options to correct big toe joint arthritis?

The options for surgery vary depending on the severity of the symptoms and the amount of arthritis occurring at the joint.  If there is a minimal amount of big toe joint arthritis, then simple procedures can be performed to help alleviate symptoms.  A patient with hallux limitus will have a small amount of extra bone on the top and sides of the great toe joint.  This extra bone is the reason for the limited range of motion and pain.  By removing this excess bone the range of motion of the joint can be reestablished and the pain and swelling will be reduced.  This can be done by making very tiny openings in the skin at the joint and using a burr to smooth out any arthritic bone.  This procedure is very effective for patients with mild to moderate joint disease and is performed in the office under local anesthesia. 

The more severe big toe joint arthritis or hallux rigidus requires much more aggressive techniques to relieve symptoms.  These options include resecting portions of the joint, replacing the joint with an implant, and fusion of the joint.  Resection of the joint is when a saw is used to clean up the arthritic bone around the joint.  A wedge of bone is also resected on either side of the joint to create an increased space allowing for movement of the great toe.  This procedure is very effective and preserves the toe joint.  Total replacement of the great toe joint can be performed with several types of implants.  In short, the arthritic bone is removed and a device is implanted into the joint to allow for movement.  Implants are very effective as well and the type of implant is decided based on surgeon comfort and reliability.  Finally, there is a fusion of the great toe joint for big toe joint arthritis.  This procedure is performed usually after all conservative therapy and other surgical options have been explored.  The procedure stops any motion at the great toe joint and is the most effective and predictable surgical option.  When the joint is fused the surgeon will make sure to place the great toe in a proper position so that walking will not be inhibited.  Many studies have shown that fusion is the most consistent procedure in alleviating arthritic toe pain.  The caveat is that the toe will no longer accommodate a variety of shoe types and this is something the patient will have to deal with after the surgery. 

How long is the recovery period after surgery for big toe joint arthritis?

The recovery period is dependent upon the surgical procedure performed.  The fusion type procedure will require the patient to be off of their foot for at least 6-8 weeks.  This is because in order for the fusion to heal there can be no motion to the joint.  If motion occurs then the joint position may change causing increased symptoms or a failed procedure.  For the rest of the procedures the patient may be allowed to walk with the assistance of a walking boot.  The boot helps to protect the surgical site and will also compress the foot to decrease swelling.  If the patient experiences moderate to severe pain after surgery then crutches or a knee scooter will be used by the patient.  The patient will walk in a regular shoe between four to six weeks and full recovery is expected between three to six months.  Physical therapy is crucial to the recovery of the patient and is started after the stitches are removed.  Stiffness of the joint after surgery is common and therefore physical therapy is initiated as early as possible. 

How do I prevent hallux limitus/rigidus?

Custom orthotics is the number one way to prevent arthritis to the great toe.  If the proper alignment of the foot can be maintained when walking then the abnormal pull of the muscles will decrease and therefore help to prevent the symptoms.  If the medial arch is supported then the arches will not collapse.  Avoiding trauma to the area is very helpful but can be hard to avoid.  Also wearing proper shoe gear when performing physical activities will help to avoid unnecessary trauma to the great toe joint.  Playing soccer bare foot or running bare foot is a recipe for disaster and is not advised if you have big toe joint arthritis.

Article provided by Advanced Podiatry

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