One of the more common causes of arthritis in the foot happens at the base of the big toe in the joint known as the metatarsophalangeal or the MTP joint.
This is a vital joint because it bends every time we take a step. When the MTP joint starts to stiffen, walking becomes very painful and difficult. Arthritis of the big toe is known as hallux rigidus and affects activities such as running and walking up hills. The more common symptoms of hallux rigidus include:
● Pain in the joint when you push-off on the toes when walking
● Swelling around the joint
● A bump, bunion or callus, that develops on the top of the foot
● Stiffness in the big toe and the inability to bend it up or down
These symptoms worsen when the big toe bends upwards. In the MTP joint, the ends of the bones are covered by a smooth articular cartilage. When wear and tear of this cartilage happens, these raw bone ends rub together and a bone spur or overgrowth can develop. This overgrowth can prevent the toe from bending when we walk—this is what results in a stiff big toe.
Hallux rigidus is usually diagnosed in adults between the ages of 30 and 60. We still don’t know why stiffness of the big toe affects some people and not others. It may result from an injury to the toe or from differences in foot anatomy that increase stress on the joint.
If you experience pain when you bend your toe or you find yourself walking on the outside of your foot because of this pain, I recommend seeing your doctor right away. Treating this condition is much easier when it is caught early. Despite feeling the pain, patients often wait until they see a bony bump on the top of the foot which means the bone spurs have already developed and the condition will be more difficult to treat.
I usually start off by examining the foot and looking for evidence of bone spurs. I will ask the patient to move their toe around to see how much motion is possible without pain. X-rays will help show the location and size of any bone spurs as well as the damage in the joint space and cartilage.
There are both non-surgical and surgical treatments for hallux rigidus. Pain relievers and anti-inflammatory medication like ibuprofen are often prescribed to help reduce the swelling. Ice packs also will help, but these methods usually are not enough from stopping the condition from progressing.
I also recommend wearing stiff-soled shoes which limit the motion at the base of the big toe. Inserts can be made for shoes that help support existing footwear. Sometimes adding a rocker bottom to the shoe can help. A rocker bottom is a curved sole that acts like the bottom of a rocking chair—it helps the foot smoothly transition from the heel to the toe while walking. The rocker bottom also limits the movement of the arthritic toe joint.
These initial measures are what I recommend before we look into surgery. A surgical procedure known as cheilectomy is one option when the damage is mild or moderate. The procedure usually involves removing the bone spurs as well as a small portion of bone so that the toe has more room to bend.
Another option is a procedure that fuses the bones together at the base of the big toe. This surgery includes making a cut over the joint, and the joint surfaces are cut out and prepared so that the big toe sits in a good position. The bones are then fixed together with screws. With a fusion operation, the reason that the joint surfaces are removed is so that the two bones will heal together. If there is no movement at the joint, there will be no pain. However the joint will be permanently stiff. But patients can usually work normally because the pain has been eliminated.
Podiatrist Peter A. Bellezza, DPM, MS, is a member of the medical staff of the Bristol Health Medical Group and Bristol Hospital’s Center for Orthopedic and Spine Health. Dr. Bellezza has a special interest in general podiatry, foot and ankle reconstruction, total ankle replacement, and sports medicine. He is accepting new patients and is located conveniently at offices in Bristol, New Britain, and Southington. To schedule an appointment, please call 1-833-4BHDOCS or visit bristolhospital.org.