Arthritis in the big toe joint can be very painful and debilitating. This joint is very important for a proper walking pattern, and when it does not function correctly, there can be significant pain, which limits activity and can lead to the health problems associated with inactivity. Joint cartilage cannot be re-grown and when the cartilage is gone, the body does not replace it properly. Loss of joint cartilage is also known as arthritis. There has been a lot of research into re-growing or cloning cartilage but scientists say that this technology is at least 15 years away from being a reality. Arthritis is a growing problem in the United States and the foot is a very commonly affected area.
The signs and symptoms of big toe joint arthritis are pain, swelling, redness, limitation in the movement of the joint, grinding with movement and stiffness. These symptoms begin slowly and gradually worsen over time. There are various levels of arthritis, which are usually broken down into mild, moderate and severe categories. Each of these types has certain features and treatment options are based on the severity of the arthritis.
To determine the severity of the arthritis, an examination and x-rays are needed. Your doctor will be able to determine the level of arthritis in the joint and propose recommended treatments based on these findings. It is important to remember that not being proactive in treatment can lead to worsening of the condition and increased pain, so time is of the essence. Arthritis is a loss of the cartilage (which provides a smooth surface for gliding) on the bones in the joint, causing grinding of bone on bone which can be very painful. The bones then form spurs which also contribute to the pain.
For mild arthritis, non steroidal anti inflammatory drugs (NSAIDs) in the form of oral and topical medication is the mainstay of therapy along with an emphasis on preventing worsening damage to the joint. Proper shoe gear and arch support is very important for prevention. Physical therapy can also help to improve the range of motion in the joint. In some cases, surgical intervention at this stage can to realign the joint to help prevent worsening of arthritis as well.
For moderate arthritis, NSAIDs, steroids (both orally and injected) and proper arch support are the main treatments. At this stage, custom orthotics are usually recommended to help the joint function as close to normally as possible. Again, surgery to help realign the joint can be very beneficial. Moderate arthritis is by far the most common stage at the time of diagnosis and an aggressive treatment strategy is important to help prevent worsening.
For severe arthritis the options become more limited. All of the above treatments can be used and in some cases are effective. However, severe arthritis in the big toe joint is difficult to treat. Custom orthotics are a must to decrease the stress and motion across the joint. Surgery is most often needed once arthritis becomes severe but is reserved for when other interventions have failed to improve the pain. Surgical options are unfortunately limited and consist of two main types: joint replacement and fusion of the joint.
Replacement of the big toe joint has become more common in the two decades. There are different types depending on which bone has the most severe loss of cartilage. These implants are similar to those used for knee and hip replacements. Using these implants allows for improved range of motion with significantly less pain in the joint. However, these implants have a short life span in comparison to other joint replacements, lasting 5-7 years on average as compared with 15+ years in the hip and knee. This short life span is due to the mechanics of the big toe joint and the small surface area of the joint as compared with the large surface area of the hip or knee. The partial great toe joint replacement is designed to take away as little natural tissue and bone as possible but help reduce pain and improved motion of the joint. It is an alternative to joint destructive procedures such as fusion of the joint (where the joint motion is completely taken away). The partial great toe joint replacement system is indicated for those patients between the ages of 40 and 60 in general and is an intermediate step to avoid joint fusion. This procedure allows for being more active with reduced pain and improved motion. The implant is made of titanium and the risk of allergy or issues with the implant are very rare.
Fusion of the big toe joint, though it may sound extreme, is a very good treatment for severe arthritis. When the joint becomes severely arthritic, the joint is very limited in its movement anyhow, and fusion changes the mechanics of walking very little compared with before surgery, but there is significantly less pain with walking. Fusing the joints involves making the two bones into one, stopping the painful motion of the joint. This procedure has been performed for decades and has a high degree of success.
As with any surgery, there are risks involved. It is important to talk with your doctor about these risks and which treatments are appropriate for your particular condition. The doctors at Advanced Foot and Ankle Center are highly trained and experienced all treatments for big toe joint arthritis. Call today for an appointment.
Eric Silvers, DPM
Dustin Lloyd, DPM
Christopher Witt, DPM