Big Toe Arthritis

What is it – What are the Symptoms & Causes – Treatments

Dr. Reed speak about big toe arthritis and the latest trusted treatment – Cartiva.


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.


Cartiva – A New Treatment Option for Big Toe Arthritis

Patients’ Frequently Asked Questions

Q. What is Cartiva used to treat?
Cartiva treats painful arthritis in the joint of the big toe. This arthritis involves the wearing down of the cartilage tissue in the big toe joint.

Q. Is Cartiva right for me?
Only a physician can determine if Cartiva is right for you and your unique circumstances. However, if you suffer from osteoarthritis in your big toe and want to pursue a solution that will not inhibit your foot’s motion, you may be a great candidate for Cartiva.

Q. What is Cartiva made of?
The implant is composed of a biocompatible, durable, slippery organic polymer that functions similarly to natural cartilage.

Q. What is the procedure for Cartiva?
Cartiva is used in a surgical procedure that is performed in an operating room using general anesthesia often combined with a regional ankle anesthetic. An incision (approximately 2 inches long) is made along the top of your toe joint. Then, your surgeon will use special tools to remove bone to make a hole for the implant.

Your surgeon will then place the Cartiva into the hole. The Cartiva implant provides a smooth, slippery, load-bearing surface. The Cartiva stays in place without the use of cement or glue. Then, your surgeon will close the cut in your toe with stitches. The entire surgery typically takes 25-35 minutes.

Q. How does recovery compare with fusion?
With Cartiva, your foot will be weight bearing immediately following surgery. You should begin exercises that move your joint immediately. Your doctor may instruct you in the exercises to undertake in order to regain movement of your toe. Fusion normally takes 6 weeks before your foot will be weight bearing.

Q. How long will Cartiva last?
Ideally, a lifetime. Should the implant need to be removed or replaced, its use does not prevent the use of a fusion.