Arthritis in the Toes
The most common site of toe arthritis is at the base of the big toe. This joint is called the metatarsophalangeal, or MTP joint. The joint is important because it bends with each step and a toe disorder such as this can cause the MTP joint to stiffen as walking can become painful and more difficult. In the MTP joint, as in any joint, the ends of the bones are covered by a smooth articular cartilage. If there is damage to the articular cartilage, whether by a specific injury or simply through wear-and-tear, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it should, resulting in a stiff big toe, or hallux rigidus.
What is Hallux Rigidus?
Hallux rigidus usually develops in adults between the ages of 30 and 60, but may develop at a younger age in somebody who has had trauma to the toe joint or is particularly athletic. It is not known why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.
Toe Arthritis Symptoms
Some of the signs and symptoms patients experience include pain in the joint when active, especially as pushing-off on the toes when walking; swelling around the joint; a bump, like a bunion or callus, that develops on the top of the foot (dorsal bunion); and/or stiffness in the big toe and an inability to bend it up or down.
Solutions for Arthritis in the Toes
Medical attention should be considered if the toe is difficult to bend up or down, or pain forces the person to walk on the outside of his or her foot. Hallux rigidus responds better to treatment the earlier it is diagnosed. If a patient waits until a bony bump on the top of the foot is visible, the bone spurs will have already developed and the condition may be more difficult to treat. X-rays will show the location and size of any bone spurs, as well as the degree of degeneration in the joint space and cartilage.
Surgical options for hallux rigidus depend upon the degree of arthritis within the joint. Cheilectomy is usually recommended when damage is mild or moderate. This involves removing the bone spurs as well as a portion of the foot bone, so the toe has more room to bend. The incision is made on the top of the foot. The toe and the operative site may remain swollen for several months after the operation, and a wooden-soled sandal must be worn for two weeks after the surgery. Most patients do experience long-term relief; however, the underlying arthritis in the joint is not removed, so some pain may persist with additional surgery possible in the future.
Arthrodesis is a procedure where the bones of the big toe joint are welded, or fused together. This is often recommended when the damage to the cartilage is severe. The damaged cartilage is removed and pins, screws, or a plate are used to fix the joint in a permanent position. This type of surgery means that the toe can not be bent at all at this specific joint but it is the most reliable method in which to reduce pain in severe cases. During the recovery, patients can walk immediately but are required to use a wooden-soled rigid shoe for the first six weeks after surgery.
Toe Joint Replacement
The third option for this condition is arthroplasty which is a joint replacement and may be indicated for select patient scenarios. With interpositional arthroplasty, a soft tissue graft is placed to work as a cushion for the big toe joint, and can be appropriate for select individuals instead of metal joint replacements. This procedure may relieve pain and preserve joint motion.
Alternative Toe Arthritis Treatment
Non-operative treatments such as anti-inflammatory medications and icing may ease the pain but will not stop the condition from progressing. Wearing a shoe with a large toe box will reduce the pressure on the toe, and patients who wear high heeled shoes will be advised against that. A stiff-soled shoe, sometimes with a rocker or roller bottom design, may provide relief as this type of shoe reduces the amount of bend in the big toe.
Big Toe Arthritis Treatment in Chicagoland
Dr. Vora commonly treats this condition and has written and lectured about the primary treatments for it as well as options for salvage after previously failed procedures for arthritis of the big toe joint. Dr. Vora has published his outcomes with interposition arthroplasty and has also helped design implants utilized for big toe fusion. To learn more about Dr. Vora’s orthopedic services, innovative toe surgery technique or to schedule a consultation to diagnose your toe pain, please contact one of our Chicago-based office locations to begin your road to recovery.
Modified from the AAOS
What’s the history behind Cartiva?
As explained by Dr. Anand Vora.
As Cartiva is a new implant that’s been designed that has some efficacy in terms of relieving pain as compared to other joint replacements. It has the same efficacy or the same type of pain relief as a joint fusion in the properly selected patients, while still preserving motion. It’s something new, with only limited intermediate term follow up, but with the intermediate term follow up on this procedure, outcomes have been really good. So it’s a great procedure in our practice for patients that want to preserve their big toe motion, understanding the short term follow up only. Also, for some of the patients that have big toe arthritis, but still have a lot of motion, one of the downsides with the fusion is that motion is eliminated, and in those particular patients, Cartiva seems to be an excellent alternative.