Great Toe Arthritis

The term arthritis literally means inflammation of a joint, but is generally used to describe any condition in which there is damage to the cartilage.  Inflammation is the body's natural response to injury, and the early signs present as redness, swelling, heat and pain.

The first toe has an important function to play during walking. The basal joint of the first toe, known as metatarsophalangeal (MTP) joint plays a vital role in the bending of the toe every time one takes a step forward. The ends of the joint bones are covered with a smooth articular cartilage. Any injury or wear-and-tear of this cartilage results in the rubbing of the bones or the development of bone projections. With time, these projections become larger and result in the stiffening of the toe. Various other conditions like infection, inflammation, trauma or malalignment of the joint can damage the cartilage. These conditions prevent bending of the toe, and makes walking difficult and painful.

Symptoms of first toe arthritis include:

• Pain in the joint
• Swelling around the joint
• Development of a bump or callus (hardened part of the skin) on the top of foot
• Inability to bend up and down
• Stiffness

First toe joint cartilage injuries are diagnosed by examining your foot for the presence of bony projections (bone spurs). Your doctor will move your toe around to evaluate the range of motion till you experience pain. Your doctor may order X-rays or MRIs to analyse the intensity of cartilage degeneration, and to determine the size and location of bone projections on the toe.

First toe joint cartilage injuries can be treated based on the severity of the disease during diagnosis. Treatment options include:

Conservative measures

Anti-inflammatory agents and pain relievers will be prescribed to reduce pain and swelling of the joint. Taking contrast baths (using hot and cold water alternately) or applying ice packs may help control symptoms for a short period. In order to reduce pressure on your affected toe, you may have to stop wearing high heels and wear shoes containing a large toe box. Your doctor may also suggest shoes with a stiff-sole made up of a metal brace or steel shank, or rocker/roller bottom shoes. These designs will reduce the need to bend the first toe and will support your foot while walking.

Surgical therapies

The surgical procedures include:

• Cheilectomy (Removal of bone projections)
  This procedure is recommended for treating mild to moderate damage. Your doctor will make an incision on the top of the foot to remove the bony projections and a part of the foot bone. This allows more space for the toe to bend and move freely. The procedure removes up to 40% of the MTP joint surface. After the procedure, swelling around the joint may persist for several months and you may have to wear a wooden-soled sandal for few weeks.

• Arthrodesis (Bone fusion)
  This procedure is recommended in cases of severe damage to the cartilage. Your doctor will remove the damaged cartilage and permanently fix the MTP joint with screws, pins or a plate. This procedure prevents bending of the toe but is the most effective approach to reduce pain. The fixed bones will gradually grow and fuse together.

• Arthroplasty (Joint replacement surgery)
  This procedure is recommended in older patients who have few functional demands on their feet. Your doctor will remove the joint surfaces (bone and cartilage on both sides of joint bones) and place an artificial joint into the space. The surgery preserves the motion of joint and relieves pain.