Great Toe Arthritis

As winter draws to a close, most of us naturally become more active and do more walking. We also tend to wear more open, less supportive shoes. If you find yourself with pain in your great toe when going on a walk, hike or jog; or if you've had aching in that toe when you've been out Nordic skiing this winter, you may have developed arthritis in your great toe joint.

 

Arthritis is a progressive disease that is caused by inflammation and the break down of cartilage in a joint. It can cause pain, aching and deformity of the joint. The great toe joint is a common location of arthritis and can cause the joint to becomes stiff, deformed and painful. Arthritis develops as a result of trauma to a joint. It could be something traumatic like getting stepped on by a horse or having a hockey puck bounce off your foot, or it can be from the repetitive motion at the joint that occurs during walking or running. No person has perfect biomechanics in their feet, so no person's joints are perfectly aligned. If they were, there would be a lot less arthritis in the foot! When the cartilage in a joint is damaged, any motion in the joint rubs on the damaged bone which will wear off more cartilage. Eventually you end up with a joint that is “bone-on-bone.”

 

When you see your podiatrist for great toe joint pain, they will likely take x-rays. At Range Foot & Ankle, we are able to take x-rays right in the office during your exam. There are many treatment options available for great toe joint arthritis. Your x-rays, overall health and functional goals are used to determine what the best treatment plan will be for you.

 

Non-surgical treatment options can include custom orthotics to decrease the motion and pain at the great toe joint. In the beginning stages, rest, ice and NSAIDs can be used to relieve pain. Shoe modifications, such as wearing a shoe with a rigid sole, are often helpful as well. When conservative treatment fails to provide pain relief, there are various surgical options ranging from removing any bone spurs present to fusing the joint or replacing the joint. Each treatment comes with a different recovery period, but is usually done as outpatient surgeries with no overnight hospital stay required.

 

Removing bone spurs is called a Cheilectomy. It involves removing the bone spur on the top of the metatarsal. The bone spur restricts the motion in the joint, so by removing it you regain that lost motion.

 

Great toe joint replacements have been around since the 1950's and have evolved significantly since then. Just like the hip or knee, either a total or partial joint replacement can be done. The goal is to relieve pain and restore motion in the great toe joint. After surgery, most patients are encouraged to walk in a surgical shoe the day of surgery and return to full activities within three months.

 

Great toe joint fusions have been around for even longer than joint replacements and continue to be a standard of treatment. The surgery does not restore motion that has been lost in the joint over the years. Instead, the goal of surgery is to relieve pain by removing the motion in the joint. If you have additional deformities such as a large bunion, this is often a better option than a joint replacement. Patients are able to return to their normal activities after surgery, but may have difficulty wearing heels higher than 1.5”.

 

After surgery you may be in either a removable boot, cast or surgical shoe. If you need to be off your foot after surgery, there are several different options including crutches, a walker or a knee walker. With all the options available, there is no reason to suffer with foot pain.

Author
Dr Katie Evans Dr Katie Evans writes a monthly column in the Hometown Focus. The articles cover a variety of issues concerning the foot and ankle. If you have any recommendations for future articles, email them to rangefootandankle@gmail.com.

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