OakLeaf Medical Network Healthy Viewpoints, Winter 2003
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Robert Hume, DPM

Arthritis of the Great Toe

Robert Hume, DPM
Reconstructive Foot Surgery
Chippewa Valley Orthopedics & Sports Medicine
Eau Claire

Our big toe bears a tremendous amount of stress with every step we take. We don’t notice it until a problem such as arthritis develops.  The most common arthritic joint of the foot is the great toe (big toe).  This condition is known as hallux rigidus.  The pain associated with this condition can be very severe, even disabling.  It will be uncomfortable with every step, every time we stoop down, climb, or even stand.  As the great toe’s flexibility decreases, weight is borne increasingly on the outside of the foot causing symptoms on the outside of the leg, knee, hip, and lower back because of the alteration of normal gait. 

An x-ray of osteoarthritis affecting the big toe. Joint replacement will be necessary to relieve the pain and allow mobility. Unfortunately, the patient could have saved the joint if they had sought treatment earlier.

Arthritic symptoms are typically present early and become progressive, even while patients are in their twenties.  These symptoms include: pain and stiffness (worse in cold, damp weather), swelling, tenderness, and difficulty with activities that require increased flexion, such as running. An enlargement of the joint also becomes apparent as the condition progresses. Eventually the toe hardly bends at all.

This arthritic condition certainly can be caused by trauma such as a fracture, but it is much more commonly associated with faulty foot structure and mechanics.  It is the typical wear and tear type of arthritis that develops in all of us as we age, but conditions such as fallen arches or excessive rolling in at the ankle greatly accelerate its development. After time, spurs develop around the joint making the management of the condition even more difficult.  For these reasons, patients should seek treatment when they first notice the early symptoms.

Early treatment can involve shoe modifications. Most running shoes have what is called “high toe taper” which means that the sole under the ball of the foot is much thicker than at the toe. This allows a forward rocking motion of the shoe which therefore requires less flexion of the big toe joint. Orthotics may be of great benefit, but this is one condition that should be aggressively treated if conservative measures do not control symptoms.  Let’s forget the high heels!  Continual aching means progressive loss of the joint’s cartilage that ultimately will require fusion or joint replacement.  Surgery prior to the complete destruction of the joint is a better alternative.

Early surgical procedures involve cleaning up the joint, removing spurs, and promoting cartilage development, as well as repositioning or realigning the joint to improve function.  These procedures are used to preserve the joint.  When the joint can no longer be preserved because the damage is too severe, fusions or joint replacement become necessary.  Some surgeons prefer fusions while others opt for joint replacement.  In my experience, joint replacement is the better alternative allowing immediate post-operative weight bearing and better overall foot function. Treatment needs to be individualized depending on the patient’s age, occupation and activity level. 

There are some patients who have severe arthritic involvement of the joint, but have no symptoms.  Treatment would be easier if we knew ahead of time who those people are, but treatment is based on probabilities of what is most likely to occur.

Healthy feet become increasingly important as we age.
Procrastinating until symptoms are so severe that early surgical procedures are not possible will result in a worse outcome for the majority of patients.  If you have some of the signs and symptoms of this condition, see your podiatrist.  It will make a positive difference in the quality of your life!

For information or to schedule an appointment with Dr. Hume, Chippewa Valley Orthopedics & Sports Medicine, Eau Claire, call 800-322-1747, or visit www.cvosm.com.