Big Toe Arthritis

A Patient's Guide

Big toe arthritis, medically referred to as hallux rigidus, is a degenerative joint disease affecting the first metatarsophalangeal (MTP) joint at the base of the big toe. This condition is characterised by the progressive wear and tear of the cartilage within the joint, leading to pain, stiffness, and impaired mobility. Hallux rigidus is a common form of arthritis and can significantly impact a person’s quality of life, making everyday activities such as walking, running, and even standing uncomfortable. Understanding the symptoms, diagnostic approaches, and treatment options is essential for managing this condition effectively.

Symptoms and Signs

The symptoms and signs of big toe arthritis can vary depending on the severity of the condition. Common symptoms include::

Pain: The primary symptom of hallux rigidus is pain at the base of the big toe, which may be exacerbated by activity. Initially, the pain might only occur during activities such as walking or running, but as the disease progresses, it can become constant, even at rest.

Stiffness: Patients often experience stiffness in the big toe, particularly in the morning or after periods of inactivity. This stiffness can limit the range of motion, making it difficult to bend the toe up and down.

Bony Bumps (Osteophytes): Over time, the body may produce extra bone growths called osteophytes around the affected joint. These bony bumps can be felt or seen on the top of the toe joint and may contribute to pain and reduced mobility.
Difficulty walking and wearing shoes: To avoid pain, individuals may unconsciously change the way they walk, leading to an altered gait. This can cause additional stress on other parts of the foot, ankle, and lower body, potentially leading to secondary issues such as knee or hip pain. As the condition worsens, patients might find it challenging to wear certain types of shoes, particularly those with a narrow toe box or high heels due to discomfort and swelling.

Assessment

Diagnosing big toe arthritis involves a combination of clinical evaluation, imaging studies, and sometimes laboratory tests. A medical history requires details about the onset, duration, and intensity of symptoms, whilst examination will assess range of motion, swelling, tenderness, bony growths, and walking. Investigations include:

X-Rays/Standing CT: X-ray imaging or a standing CT scan is a crucial tool in diagnosing hallux rigidus. It helps visualise the extent of joint degeneration, cartilage loss, and the presence of osteophytes. They can also reveal any narrowing of the joint space and changes in bone structure.
Magnetic Resonance Imaging (MRI): In some cases, an MRI may be ordered to provide a more detailed view of the soft tissues, including cartilage, tendons, and ligaments around the joint. This can help assess the extent of cartilage damage and detect any associated conditions such as synovitis (inflammation of the joint lining).
Ultrasound: Ultrasound imaging can be useful in evaluating soft tissue structures around the joint and detecting fluid accumulation, which may indicate inflammation. It is a non-invasive and accessible imaging modality that can complement other investigations.
Blood Tests: While blood tests are not typically used to diagnose hallux rigidus, they may be conducted to rule out other types of arthritis, such as rheumatoid arthritis or gout, which can present with similar symptoms.

Conservative Treatment

Treatment for big toe arthritis aims to relieve pain, improve function, and slow the progression of the disease. The treatment plan can vary depending on the severity of symptoms and the degree of joint damage. Options include:

Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen can help reduce pain and inflammation. In some cases, corticosteroid injections may be administered directly into the joint to provide temporary relief.
Orthotics: Custom-made orthotic devices or shoe inserts can provide support and alleviate pressure on the affected joint. Shoes with a stiff sole or rocker-bottom design can also reduce pain during walking.
Physiotherapy: Focused exercises can help maintain joint mobility, strengthen the muscles around the joint, and reduced forefoot overload improving overall foot function.
Activity Modification: Avoiding activities that exacerbate pain, such as running or jumping, and opting for low-impact exercises like swimming, cross-training or cycling can help manage symptoms.

Surgical Treatment

Moderate to severe arthritis is more likely to need advanced treatment of surgery. Options will depend upon your goals and the severity of disease:

Cheilectomy: This surgical procedure involves removing bone spurs and part of the joint to improve range of motion and relieve pain. It is typically recommended for mild to moderate cases.
Arthrodesis (Joint Fusion): For severe arthritis, arthrodesis may be performed to fuse the bones of the joint together, eliminating pain but sacrificing joint motion. This procedure is effective in providing pain relief and stabilising the joint.
Arthroplasty (Joint Replacement): In some cases, the damaged joint may be replaced with an artificial implant. This option aims to maintain some degree of joint motion while reducing pain. It is generally considered for patients with advanced arthritis who are not candidates for joint fusion.

Summary

Big toe arthritis, or hallux rigidus, is a common condition that can significantly impact daily activities and overall quality of life. Early recognition of symptoms and appropriate diagnostic investigations are crucial for managing the condition effectively. While conservative treatments can provide significant relief and slow disease progression, surgical options are available for advanced cases to restore function and alleviate pain. Consulting with a healthcare professional with experience of manging this condition such as Shelain Patel, who can develop a tailored treatment plan is essential for achieving the best possible outcomes.