Arthritis of the Big Toe Joint

There are many different types of arthritis. Osteoarthritis, which can occur in any joint in the body, is one of the most common types of arthritis, and the big toe joint is one of the most common joints affected by this condition. When arthritis appears in that joint, it reflects the late stage of a disorder called hallux rigidus. The term “hallux” refers to the big toe, while “rigidus” indicates that the toe is rigid and can’t move.

In hallux rigidus, the big toe joint “jams” when walking. This jamming results in a breakdown of the joint that causes pain and eventually arthritis.  Hallux rigidus can be very troubling and even disabling because we use the big toe in almost every foot movement, including walking, stooping, climbing stairs, and even standing. Some people with hallux rigidus mistakenly think they have a bunion, which also affects the big toe, however, these two disorders are very different from each other, and are treated differently.

Hallux rigidus is often a slow and progressive process. It may first appear as joint swelling and redness that occurs only during certain activities, or when wearing shoes that place a lot of pressure and strain on the joint.  As the condition progresses, it moves from what is called hallux limitus, when motion of the big toe is only somewhat limited, to hallux rigidus, when the joint becomes stiffer and loses motion. This stiffness produces further pain and destruction of the joint, resulting in arthritis.

What causes hallux rigidus? In most cases, hallux rigidus is caused by structural problems of the foot. These problems are related to the general shape of your foot which bring about slight changes to the function of your foot. Hallux rigidus can also develop from overuse of the big toe, especially among people who place increased stress on that toe, such as workers who frequently stoop or squat or those involved in ballet or sprinting. Other contributors to hallux rigidus include a previous injury (such as stubbing your toe), wearing certain types of shoes (such as high heels), and other disorders.

In the early stages of this condition, the symptoms include pain and stiffness in the big toe during use, such as walking, bending, and even standing. You may notice difficulty in performing certain activities, such as squatting or running. Cold, damp weather often aggravates the pain and stiffness. Swelling and inflammation around the joint might also occur.

In the later stages, as the condition worsens, additional symptoms develop. The range of motion of the big toe progressively decreases, and in the very last stage, the toe is rigid and cannot bend. Hallux rigidus may also progress to the point where there may be pain even when the foot isn’t being used. The later stages are also often associated with permanent changes to the joint from arthritis that include bone spurs and enlargement of the joint. As a result of these changes, you may find it difficult to wear certain shoes or participate in certain recreational or occupational activities.

Although having this condition is not an emergency situation, the earlier it’s diagnosed and treated, the better your chances are for slowing the progression. That means that the best time to see a foot and ankle surgeon is when you first notice symptoms. The sooner this condition is diagnosed, the easier it is to treat. If you wait until the end stage, surgery will be your only option of treatment.

In evaluating and diagnosing your condition, your Houston and Katy foot and ankle surgeons will examine your feet and evaluate how much motion remains in the big toe joint. The surgeons may also order x-rays to determine how much arthritis is present. X-rays can also detect the presence of bone spurs or other abnormalities. Once the evaluation is completed, your Dr. Menchin and Dr. Hetman will develop a treatment plan that best suits your case.

Early treatment may prevent or postpone the need for surgery in the future. Let’s take a look at these early, nonsurgical treatment measures.

First, Dr. Menchin and Dr. Hetman may recommend footwear that is most suitable for your foot structure and mechanics. This could involve wearing shoes with a wide toe box, so there will be less pressure on your toe. Also, shoes with stiff or rocker-bottom soles are often recommended because they largely eliminate bending of the toe. Orthotic devices, such as custom shoe inserts, may also be prescribed to improve how your foot functions. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce the pain and inflammation. In some cases, corticosteroid injections are used to reduce inflammation and pain. Finally, physical therapy that involves exercises may be recommended for some patients.

In some cases of hallux rigidus, the condition may have progressed to the point where surgery is the only way to eliminate or reduce the pain of arthritis in the big toe. Various types of surgery are available to treat this condition. In selecting the procedure or combination of procedures for your particular case, Dr. Menchin and Dr. Hetman will take into consideration the extent of your condition based on x-ray findings, your age, your activity level, and other factors. Whichever type of surgery is performed, the goal is to reduce or eliminate your pain and improve your quality of life.

Remember, your big toe plays a big role in just about every movement your foot makes. It’s even important when you’re standing. So if your big toe isn’t feeling right, see a Houston and Katy foot and ankle surgeon soon for a complete evaluation and effective treatment.  

Katy residents should come to our new office on Greenhouse and experience why Foot Specialists of Memorial was the top rated foot and ankle office in the Memorial area the past 4 out of 5 years.


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