What is big toe arthritis?
The medical term for big toe arthritis is Hallux Rigidus. Like other forms of joint arthritis, it is the result of wear and tear of the big toe joint surfaces. It is more common in people who have led active lives and worn out the joint, in those who have suffered injuries to the joint and for some, there is a genetic inheritance.
What are the symptoms of big toe arthritis?
Early signs of big toe arthritis are pain and deformity. The initial pain is often described as a deep ache in the joint after periods of activity. Patients will often notice hard lumps on the top of the joint. These are called osteophytes.
As the condition progresses, the pain may become more severe and can even cause disruption of sleep. The lumps on the top of the toe may become more pronounced and stiffness is often associated with these changes.
How is big toe arthritis diagnosed?
A good history and examination by a Foot and Ankle Specialist is important in coming to the correct diagnosis. X-Rays will often reveal the changes to the joint surfaces and the abnormal lumps around the joint. MRI may be indicated in those who have fairly normal X-rays but symptoms suggestive of joint wear and tear
How is big toe arthritis treated?
Patients should always try simple over the counter pain killers if their pain is only sporadic. Stiff soled shoes can give good initial pain relief because they prevent excessive movement at the joint. Some patients find a rocker bottom shoe a good way of keeping pain at bay. Injections to the joint can be used to reduce inflammation around the joint and for some people this may be the only treatment required.
The surgical options for big toe arthritis depend on the severity of the disease. If the joint surfaces are not too badly worn then debridement of the bony lumps can give significant relief. This is called a cheilectomy. Severe joint disease is best treated with a fusion of the joint. This will eliminate the pain but has the downside of permanently stopping movement at the big toe joint. This is likely to prevent the patient from wearing a significant heeled shoe. For low demand patients, a form of joint replacement where a plastic plug is placed in the joint can be a successful treatment in improving pain and maintaining movement. This does, however, have a higher failure rate than the other operations.