What is Arthritis in the Big Toe Joint?
The medical term for the big toe joint is the first metatarsophalangeal joint. When arthritis affects this joint you can get pain, cartilage damage, stiffness and bone spurs. Over time the joint will typically get stiffer and more painful. Gouty arthritis, Rheumatoid arthritis, Psoriatoc arthritis, and Osteoarthritis are all different form of arthritis in the big toe joint. However a form of osteoarthritis called "hallux rigidus" is by far the most common typr oe painful arthritis in the big toe joint seen in our podiatry practice in San Francisco. There are many causes of arthritis in the big toe joint, but most can be effectively treated.
Signs and Symptoms
The most common sign of arthritis in any aching joint is pain and stiffness. Arthritis is basically a condition of too much inflammation. In most cases, inflammation is a normal process that your body uses to repair injured or damaged tissue. In fact, we know that inflammation is the very phase first phase of wound healing. Without inflammation, your body just can't repair itself. But when the inflammation continues for too long, a destructive cycle of events can begin.
When you have a chronic cycle of inflammation, the tissue that lines the inside of the joint (called "synovial tissue") gets very irritated and swells. Sometimes it swells so much that it makes the joint stiff. In severe cases, the tissue can become so inflamed that it actually protrudes and can get cuaght in the joint. This pinching of the soft tissue in between the bones can be very painful. Extra nerve endings begin to grow within the joint tissues, which can cause sensitivity to weather changes.
Over time, your body attempts to protect itself from all of this painful motion. Bone spurs start to grow at the edges of the joint to decrease or block all of this painful motion. Unfortunately, the growth of bone spurs (called "osteophytes" by podiatrists) makes the problem worse. The joints can jam and lead to cartilage damage within the joint.
Eventually the cartilage damage becomes extensive enough that you get painful bone on bone grinding within the joint. When it gets to this point, foot doctors refer to the condition as "advanced degenerative joint disease." Once the destruction of the joint cartilage has occurred, you basically either need to learn to live with the pain, or have foot surgery to correct the problem.
Diagnosis of Arthritis in the Big Toe Joint
Arthritis in the big toe joint is diagnosed by your podiatrist with a history and physical exam, x-rays and some other tests. The goal when diagnosing the arthritis is to decide which condition is causing it, in addition to how much damage has been done to the joint.
Treatment of Arthritis in the Big Toe Joint
Treatment for your arthritic big toe joint will depend on the cause (traumatic arthritis, gouty arthritis, osteoarthritis, etc.) and how bad the joint articular cartilage has bee damaged. In early cases of arthritis, oral medications or steroid injections may be used to stop the inflammation in the joint. Custom orthotic (shoe inserts) may correct biomechanical problems and restore more natural motion to joint so that no further damage will occur. In other cases surgery may considered.
The are many different surgeries that are performed to repair arthritis big toe joints. Sometimes the joint can simply be "cleaned out." This is a procedure called a cheilectomy. Bone spurs are removed, and any small areas of cartilage damage is repaired. Clinical trials have shown that as long as less than 50% of the cartilage has been destroyed, this procedure seems to do well for many years. However if more than 50% of the cartilage has eroded, most of those patients end up having a return of arthritis symptoms and will have a repeat-surgery again within 5 years. For this reason, it is critical that you make sure you and your surgeon both have a good idea of the condition of the joint BEFORE you go to the operating room. As long as the correct surgical procedure is performed, you should be able to expect to have much less pain after surgery.
Click here to view a short video on Big Toe Joint implant surgery created by San Francisco Foot Surgeon Dr. Segler. WARNING: this video contains graphic surgical images from actual foot surgery.
There is no one "best cure for arthritis," and the treatment needs to carefully consider the individual goals and activities that the patient hopes to achieve after treatment. For example, if you have a fusion of the big toe joint, your pain will go away, but you will not be able to wear high heels. If you have a joint implant, you can wear high heels, but the implant maybreak down quickly and fail. If you have a joint re-alignement surgery that often works for osteoathhritis, but you have rheumatoid arthritis (and not osteoarthritis), you will almost certainly end up with an unstable joint. Make sure you explain to your foot surgeon about all of your activites that you hope to enjoy after your foot is healed. That way the two of you will be able to come up with the best treatment plan for you.
Dr. Christopher Segler is a San Francisco Podiatrist and Foot Surgeon. He has a special interest in arthritic disorders of the big toe joint. He invented and patented a surgical instrument (called the Tarsal Joint Distractor) that improved the way foot surgeons perform surgery on the articular cartilage of the foot. His podiatry practice is located in the San Francisco Bay Area.