What is it – What are the Symptoms & Causes – Treatments
Introduction
Big toe arthritis, also called 1st metatarsophalangeal (MTP) arthritis or hallux rigidus, is a common condition affecting the foot and ankle. It is the most common site for arthritis in the foot. Patients typically develop symptoms between age 30 and 60, and females are more commonly affected than men.
Presentation
Patients typically develop stiffness and decreased range of motion at the big toe, which affects walking, running, and other athletic activities. Some patients develop large bone spurs on the top of the foot, which can cause pain with shoe wear and discomfort when going up on the toes.
Causes
Sometimes trauma (a fracture or crush injury) can lead to this condition, but for most patients there is no specific inciting event. Some patients are more likely than others to develop big toe arthritis, either because of some anatomic abnormality or because of genetic predisposition.
Diagnosis
A clinical exam and x-rays can confirm the diagnosis. Generally, advanced imaging like MRI or CT scan is not required.
Treatment
Non-surgical options include anti-inflammatories, shoe wear modifications, and over-the-counter or custom inserts (orthotics). Physical therapy can be helpful to maintain range of motion. Occasionally cortisone injections into the joint can decrease inflammation for a period of time.
Surgery can be used to treat cases that fail non-operative treatment. Traditionally, a procedure called a cheilectomy can be used to remove bone spurs from the top of the big toe joint. This is recommended for mild to moderate cases of hallux rigidus. This is a joint-sparing procedure. Recovery involves walking in a surgical sandal for about 3-4 weeks after the surgery.
For moderate to severe arthritis, a fusion has until recently been the only proven surgical option. This is a joint-sacrificing procedure, in which the bones on either side of the joint are fused together with screws and possibly a plate. This reliably addresses pain symptoms but eliminates all motion at the joint. Recovery involves a period of non- or heel- weight bearing followed by fully weight bearing in a surgical sandal for 8 weeks or more after the surgery.
Surgical Options
If non-surgical treatments are no longer effective for relieving pain, a surgical option could be the next step.
Cheilectomy
Cheilectomy is surgery to remove bone spurs and bone from your foot so your big toe has enough space to bend. During cheilectomy, your surgeon removes bone spurs to relieve pain and give your joint room to move. Cheilectomy can relieve big toe pain and inflexibility.
Cartiva
Cartiva is a newer synthetic cartilage implant that is designed to replace the damaged cartilage surface. It is made from polyvinyl alcohol (PVA), a material that mimics the properties of natural cartilage.
Fusion
A big toe fusion is an operation for severe arthritis of the big toe that is painful and already stiff (hallux rigidus). It is a well-established surgical treatment and has been proven to be effective.
