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Great Toe Arthritis

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Arthritis of the big toe is very common and can be caused by many factors. Fusion of the joint may be the best option, reliably and permanently providing relief from pain.

Hallux Rigidus or arthritis of the big toe metatarsophalangeal joint is very common. It can be caused by many factors including hereditary, prior injury or trauma to the joint, systemic diseases such as rheumatoid arthritis, or often the cause in unknown. There is a broad spectrum of severity of this process but in general it involves wear and erosion of the cartilage surface of the joint leading eventually to end stage or “bone on bone” changes.

Symptoms

Pain in this joint is often described as achy in nature, especially at the end of the day after spending a lot of time on your feet. Arthritis of any joint can lead to bone spur formation around the joint. Bone spurs of this joint commonly develop on the top or dorsal side of the joint and cause a prominance which can be painful, especially in tight fitting shoes. Decreased range of motion of the joint is very common as well. Patients may find that it is painful to wear heeled shoes due to
this stiffness.

Treatment

In the milder stages of this process, often conservative management with anti-inflammatory medications, ice, activity modification, and a shoe insert called a carbon fiber plate is successful in decreasing symptoms. As the arthritis progresses, surgery may be considered. If the severity is not excessive, a procedure called a cheilectomy may be appropriate. This is a relatively simple surgery where the bone spurs are removed and the cartilage addressed. This may provide relief of pain and increased range of motion of the joint. If the arthritis is severe or cheilectomy failed to provide relief, usually fusion of this joint would be the next surgical step. This reliably and permanently relieves pain and the toe can be straightened if there is also an angular deformity.

Cheilectomy Case Example:

Cheilectomy Case Example