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Overview Of Big Toe Arthritis
In medical terms, “hallux” refers to the big toe and “rigidus” means rigid or stiff. Big toe arthritis or hallux rigidus is when your big toe becomes arthritic at the base of the big toe where the metatarsophalangeal (MTP) joint exists. It is the most common arthritic disorder of the foot, affecting 1 in 40 people over the age of 50. Hallux rigidus tends to affect females more often than males. Big toe arthritis can affect one or both feet.
The MTP joint is important and this disorder can be very troubling and even disabling since it has to bend every time you take a step whenever we walk, stoop down, climb up or even stand. In the MTP joint, like in any other joint, the ends of the bones are covered by a smooth articular cartilage. If wear-and-tear or injury damage the articular cartilage, the raw bone ends can rub together causing a bone spur that may develop on the top of the bone. This projection can prevent the toe from bending as much as it needs to when you walk. If the joint starts to stiffen, walking can become painful and difficult.
With time, it gets increasingly harder to bend the toe in the presence of the condition. Hallux rigidus is in reality a progressive condition occurring in the form of degenerative arthritis, the problem advances and the toe’s range of motion decreases as time moves on until it potentially reaches the end stage of rigidus, becoming a frozen joint.
The Underlying Causes Of Hallux Rigidus
The common causes of hallux rigidus are listed as follows:
- Familial History causing hallux rigidus through inheritance
- Osteoarthritis owing to biomechanical and structural abnormalities of the foot
- Fallen Arches susceptible to developing hallux rigidus
- Excessive Pronation (Rolling In) of the ankles responsible for the development of the condition
- Metatarsal that is long and elevated
- Injury, such as stubbing your toe against a solid object
- Overuse, especially among people engaged in activities or jobs that increase the stress on the big toe
- Inflammatory Diseases, such as rheumatoid arthritis or gout
- Idiopathic reasons occurring in majority of cases
The Signs & Symptoms Of Big Toe Arthritis
The initial signs and symptoms that present at the onset of the condition include:
- Pain & Stiffness in the big toe during walking, standing, bending, etc.
- Discomfort & Rigor aggravated by cold, damp weather
- Difficulty & Inconvenience with certain activities like running, squatting
- Swelling & Inflammation around the joint
- Inability to bend the big toe up or down
Additional symptoms that often turn the condition difficult to manage may develop as the deformity gets more rigid and serious, including:
- Pain & Discomfort even while at rest and without any activity
- Bone Spurs (Overgrowths) may develop causing difficulty in wearing shoes
- Dull, Consistent Pain in the hip, knee or lower back due to altered gait
- Limping Or Claudication in severe hallux rigidus cases
The Diagnostic Procedure Of Hallux Rigidus
Hallux rigidus is easier to treat when the condition is nipped in the bud; so, the sooner it is diagnosed, the easier it is to treat. Therefore, the ideal time to visit a foot and ankle specialist is when first symptoms are noticed. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.
In diagnosing hallux rigidus, your orthopedic surgeon would carry out the following process to come up with a perfect solution to your issue:
- A Detailed Physical Examination for general assessment and to evaluate the extent of the arthritis
- Imaging Techniques to determine the location and size of a probable bone spur, that include:
Rarely required for diagnosis
- CT Scans
- MRI Scans
The Treatment Strategies
A timely diagnosis paves the way for early treatment so that maximum benefit of noninvasive means can be derived, without having the need to go for the surgical performance.
The Noninvasive Strategy
According to your podiatric specialist, nonsurgical management is always the preferred line treatment for hallux rigidus. In several cases, early treatment may prevent or delay the need for surgery in the future. Treatment for mild or moderate cases of hallux rigidus may comprise of:
- Ice & Heat Packsapplied alternately to reduce pain and swelling
- Shoe Modificationsthat include shoes with a large toe box putting less pressure on your toe; alternatively, stiff or rocker-bottom soles may also be recommended
- Orthotic Devices that are custom-manufactured as shoe inserts and arch supports to limit motion at the MTP joint, improving foot function
- Medicationsin the form of oral NSAIDs often recommended to reduce pain and inflammation
- Injection Therapy comprising of corticosteroids or platelet-rich plasma injections may reduce inflammatory and painful condition
- Physiotherapy utilizing ultrasound or other physical therapy modalities may be arranged for to provide temporary relief
The above-stated procedures do control symptoms for a short period of time, but they aren’t sufficient to stop the condition from progressing and deteriorating.
The Surgical Strategy
In some cases, if the pain persists after the above non-surgical treatments, surgery is the only way to eliminate or reduce pain and would thus be considered. Several types of surgery are available for treatment of hallux rigidus. The type of surgery would be determined by the depth of arthritis and deformity of the toe.
In selecting the procedure or combination of procedures for your particular case, the orthopedic surgeon would rely on information based on:
- X-Ray Findings
- Your Age
- Your Activity Level
The following procedures are usually attempted either singly or as compound procedures to obtain a painless, normal-looking big toe:
- Cheilectomy (Bone Spur Removal), meant for mild to moderate damage, is removing some bone and the bone spur on top of the metatarsal and proximal phalanx to allow more space for the toe to bend up and alleviate pain caused when pushing off the toe. The benefits of this procedure are that it maintains stability and motion, and preserves the joint itself.
- Interpositional Arthroplasty (Joint Resurfacing), meant for moderate to severe hallux rigidus, offers to preserve joint motion. The 2 types of techniques employed are:
- Soft Tissue Spacer Implant, meant to resurface the joint, preserve its motion to some extent, but not an ideal pain-remover
- Synthetic Cartilage Spacer Implant, meant to preserve its motion, remove pain significantly and easily convertible to fusion process I case of failure
- Arthrodesis (Joint Fusion), performed at severe joint damage presented at advanced stages of hallux rigidus, is often treated by “welding together” the big toe joint by removing the damaged cartilage and fixing together the two bones with screws and/or plates, enabling them to grow together. The main advantage of this procedure is that it is a permanent correction to reduce pain while the major drawback is that it restricts movement of the operated big toe.
- Arthroplasty (Joint Replacement), meant to replace one or both sides of the joint with metal or plastic parts, is causing doubts among orthopedic fraternity due to reports of higher complication rates and highly variable short- and long-term outcomes. However, research into it holds a promising prospect.
The Recovery Phase
The length of the recovery period will vary depending on the procedure or set of procedures performed.
For cheilectomy and interpositional arthroplasty:
- Wearing A Hard-Soled Sandal
- Allowing Weightbearing As Tolerated For About 2 Weeks
- Gradual Return To Normal Footwear
For a fusion or procedure that cuts the bone:
- Foot Immobilization With A Cast For 4 To 8 Weeks
- Limited Weightbearing Allowed With Crutches For 2 To 3 Months
Some foot swelling, stiffness, and aching for several months after the procedure may be experienced, depending on your level of activity during the postoperative recovery phase.
The Potential Risks & Complications
- Bacterial Infection In The Wound
- Damage To Nerves & Blood Vessels
- Scarring Of The Nearby Tissues
- Failure In Removing Symptoms
- Smoking Tobacco Or Consuming Tobacco Products
- Poor Immune System