Arthritis in the Big Toe Joint
Hallux limitus/rigidus or great toe joint arthritis is arthritis of the 1st metatarsal-phalangeal joint. This condition can be caused either by direct trauma such as a old fracture or by “wear and tear”.
As the condition worsens, the motion of the great toe joint decreases and pain increases. The patient will change the way they walk which can lead to hip, knee, and ankle pain. The patient will typically abduct, or turn their foot out, and roll over the inside part of their foot in order to lessen the motion and pressure on the great toe joint. This leads to other conditions such as posterior tibial tendon dysfunction and adult acquired flat foot.
If caught early the biomechanical cause can be treated either non-surgically with custom molded orthotics or surgically preventing progression and pain. If the joint is very painful, a cortisone injection may be performed, along with an NSAID. For end stage great toe joint arthritis, a custom molded orthosis with a rigid morton’s extension that eliminates motion at the great toe joint is another conservative treatment option.
For structural causes that cannot be managed biomechanically, surgery may be necessary. Joint sparing procedures can include “cleaning up” the joint and restoring range of motion. If there is a structural deformity causing jamming, an osteotomy or bone cut can be made correcting the bone angulation.
For end stage great toe joint arthritis there are two main surgical options. A partial or total joint implant, much like a hip, knee, or ankle, can be performed for the great toe joint. This is an option for patients with lower physical demands but would like to maintain motion. The other option is a fusion. This involves removing the remaining cartilage and fusing the joint with plates and/or screws. This option does not maintain motion at the joint but allows a pain free and rigid joint for the foot to push off of. The fusion procedure is best for higher activity patients or patients who do not require great toe joint motion such as for a hobby or a job.
A newer spacer implant called Cartiva may also be an option. We will discuss this treatment in an upcoming blog post.
If you have great toe joint pain, visit the podiatrists at Advanced Foot and Ankle Center. We offer same day appointments.