Patient Education

Arthritic Big Toe

Description

Have you ever, however briefly, paused to say ‘Thank you’ to your big toe? It may deserve your gratitude more than you know. It may not look it, but your big toe is often under a lot of stress. You use it as you walk, stand, climb stairs, or squat, often exerting pressure on it equal to twice the weight of your body. Even for the lightest of us, that can be a lot of strain on a little area.

Over time, especially if the foot has some inherent structural problems, the joint in the big toe might deteriorate, resulting in hallux rigidus, or a rigid big toe joint. (‘Hallux’ is fancy medical speak for the big toe.) Basically, the joint degenerates (becomes arthritic) as the cartilage that’s normally in the joint wears away.

Slowly, the joint becomes harder to move as the space between the bones gets smaller and, if the problem gets severe enough, bone spurs (bony growths) start to form. In the beginning, you may still be able to move your big toe a bit – in this case your condition may be referred to as hallux limitus. However, as the condition worsens, the joint becomes more and more stiff until it’s extremely painful or difficult to move. Because it’s much easier to treat hallux rigidus in its early stages, it’s definitely a good idea to seek treatment before it gets bad.

For those of you who think the look of a shoe is way more important than its function (i.e. the support it offers), beware: you may be in for some pain. Those who stand on their feet all day, particularly on hard surfaces or while wearing unsupportive shoes, may begin to experience discomfort in the arch area. Usually, such pain is associated with inflammation of a ligament, the plantar fascia, that runs along the underside of the foot and attaches to the arch, helping to support it. Heel spurs can also cause plantar fasciitis (inflammation of the plantar fascia).

Symptoms

When the following start to happen to you, it might just be your big toe saying, “Whoa, there! Time to get some help down here.” Pain and stiffness in the big toe joint is likely the first symptom you’ll notice. It’ll
probably be a bit harder to stand, walk or squat; basically moving or putting pressure on the joint will cause problems. However, it’s important to be aware that, at this point, you may still be able to move your toe around normally – when you’re not on it, that is. So pay attention to discomfort during normal walking or other activities that put stress on the joint.

Arthritic joints tend to get a bit more cranky during cold and damp weather as well. Blizzards are no friend to arthritis. You might also notice that the area around your joint looks swollen, red, and warm to the touch. This is caused by inflammation, and is your body’s way of trying to fix the area by sending in more blood. Unfortunately, because of the pressure put on the tissue, it also makes things hurt a bit more.

Sometimes pain may also occur at the bottom of the big toe. Basically, as the big toe isn’t able to move up as easily while walking or otherwise using the foot, the bottom of the toe jams into the ground, and may cause a painful callus to form. (Diabetics especially should watch out for this, as the callus might develop an ulcer and become infected.)

As the hallux limitus spirals downward to turn into hallux rigidus, the problems will probably get worse. Bone spurs might develop, which will make shoes tight and uncomfortable. And high heels (which really aren’t your friends anyway) will rapidly become your outright enemies (they’ll hurt like mad to wear). The pain will likely start showing up even when you aren’t on your feet, and it may start spreading to other parts of your body, such as your hips, knees, and lower back, as they complain about the alteration in your walking movements.

Diagnosis

Thank goodness for podiatrists, eh? When you go in to see your own friendly foot doctor, he or she will likely move the big toe to determine how much it’s able to shift around. X-rays will also likely be in order, and will give your podiatrist an inside look at the joint. From the X-ray, your podiatrist should be able to see whether you’ve developed any bone spurs and how far the joint has degenerated.

Definitely go to your foot doctor when you first start to notice the symptoms. The longer you wait to make the visit, the worse your joint will get, and the harder it will be to treat.

Treatment

If you catch the budding arthritis early on, it may be possible to control the pain in your foot using non-surgical methods. Basically, this treatment can be divided into two categories: shoe adjustments (they help correct the underlying causes of the arthritis) and treatments to reduce inflammation (basically, these just help reduce pain).

Shoe adjustments may simply take the form of changing the type of shoe you wear. First of all, dump the high heels. You know it’s way past time anyway – they’ve been cruel to you for years. When selecting replacements, you’ll want to give your toes more wiggle room so your big toe joint doesn’t have as much pressure on it (you’ll want to have a thumb’s breadth between your toes and the inside end of the shoe). Also, getting shoes with stiff or rocker bottom soles will help reduce stress on the joint. Your podiatrist may also suggest orthotics to correct any misalignments in your foot and make the whole thing function a bit better.

Inflammation can be painful, but it usually will respond to treatments such as oral anti-inflammatory medication (like ibuprofen), an injection of more heavy-duty medication like cortisone right into the joint, and physical therapy (like using ultrasound on the area).

If your arthritic big toe isn’t responding to more conservative treatments, or if the problem is already so severe that the above treatments won’t have much affect, surgery may be necessary. If possible, your surgeon will try to preserve the joint by shaving the bone, removing bone spurs and other damage caused by the arthritis, and by realigning the bones of the toe into their proper positions. If the damage is severe enough, it may be necessary to fuse or replace the joint. Fusing will eliminate the movement of the arthritic joint, and is really quite effective in eliminating pain. After such a surgery, most people are still able to participate in physical activities and wear shoes (except high heels) quite normally.