One of the most common problems that I see is arthritis of the big toe joint. Arthritis is a joint disorder that is caused by the thinning or absence of cartilage in the joint. Osteoarthritis (aka the wear and tear of arthritis) is the most common form of arthritis in the big toe joint. Symptoms include, but are not limited to:
- Occasionally prominent bone spurs.
There are two routes that can be taken when dealing with arthritis of the big toe joint: non-surgical & surgical. The severity of the pain & diagnosis of your doctor will ultimately determine which direction you will take. There are five forms of non-surgical treatment that are found the most effective:
- Shoe Modification : Supportive shoes with adequate room in the toe box and a rigid rocker sole. HealthyFeetStore.com organizes podiatrist-approved footwear specifically designed for arthritis and can be found here: ARTHRITIS FOOTWEAR
- Arch Supports or Orthotics : These are formulated by your podiatrist and customized specifically for you. Implementing arch supports or orthotics into your daily footwear can help with weight distribution. This will ultimately reduce pressure through the big toe joint.
- NSAIDS : Oral tablets that help reduce swelling, inflammation & pain.
- Cortisone Injections : Injecting steroid into the joints can very quickly reduce inflammation and pain.
- Turf Toe Plate : By placing a rigid plate inside your shoe, you will ultimately slow down motion in the joint.
As discussed above, arthritis is caused by a thinning or absence of cartilage. There is no quick fix or mainstream surgery to replace cartilage, so surgery for big toe joint arthritis (excluding fusion) is only designed to alter the current environment of the joint. In turn, this will hopefully reduce some of the symptoms. Do note that you will suffer from arthritis, but most of the time pain is reduced. There are three forms of surgical treatment that can be taken to best treat arthritis of the big toe joint:
- Cheilectomy : This procedure is a "cleaning up" of the joint. Bone spurs are removed and adhesions are released. Sometimes, joint surface without cartilage is stimulated to grow back a new "pseudo-cartilage."
- Osteotomy : Osteotomy means "bone cut." The most common osteotomy is called The Austin-Youngswick. This bone cut is diagnosed to reduce pressure within the joint and improve range of motion.
- Arthrodesis : Arthrodesis is a fusion of the joint. The metatarsal bone is fused to the toe bone which completely eliminates the joint. This is the most predictable surgery to eliminate pain, however the big toe joint will not bend. Our feet have 33 joints in each foot, so if you fuse one, the other 32 will compensate. Really, the only negation to fusing the big toe is that you cannot wear a high heel greater than two inches.
Sometimes, ladies, the sacrifice is worth it!
Dr. Jeffrey S. Hurless
DPM, FACFAS Board Certified Foot & Ankle Surgeon/Podiatrist
Medical Director, HealthyFeetStore.com