Medical Edge Newspaper Column

Overuse, Injury Can Lead to Arthritis in the Big Toe

December 2, 2007
Dear Mayo Clinic:
I've been told I have arthritis at the base of my big toe. Can this problem be helped?

Answer:
Yes. Arthritis of the great toe is called hallux rigidus, which means a stiff great toe. The condition is fairly common.

The joint at the base of your big toe is a modified ball-and-socket joint, like your hip. The long bone of the foot is connected to the short bone of the big toe. The ends of the bones are cushioned by smooth elastic tissue called cartilage. When the cartilage wears away or is damaged, bone starts to rub on bone within the joint, which is the classic definition of osteoarthritis.

Typically, pain from this condition is caused by weight-bearing activity such as walking, standing, running or bending. When you rest the joint, you relieve the pain. In time, however, the joint may be painful even during rest.

Other symptoms include swelling and inflammation around the joint and the formation of painful bone spurs, which further limit toe movement. Because foot pain causes people to alter the way they walk, some develop secondary pain in their hips, knees or ankles.

Arthritis in the great toe can be caused by an abnormality in the foot's bone structure, which tends to run in families. It can also result from an injury to the joint, or from repetitive activity that causes a chronic jamming of the joint. People who play a lot of sports with jumping or kicking such as basketball and soccer may be predisposed to develop osteoarthritis in the great toe.

Conservative treatment of this condition begins with footwear. Stiff-soled or rocker-soled shoes take the stress off the toe. Many good walking or athletic shoes — called cross trainers — typically have a stiffer forefoot and a convex sole to reduce toe movement. They help alleviate pain.

Another good option is an insert in the shoe. A thin carbon graphite plate — less than a sixteenth of an inch thick — slips inside your shoe and extends beneath the great toe, making the shoe stiff and preventing the toe from moving up and down.

For treatment of pain and inflammation, you can take nonsteroidal anti-inflammatory medication or even Tylenol, but the benefits are limited because this condition is aggravated more by pressure and weight-bearing activities than by inflammation.

If the condition can't be managed conservatively, surgery may be an option.

A cheilectomy (k-eye-lec-toe-me) is a surgical procedure that involves removing the top of the joint, to get rid of any bone spurs. Once the spurs are gone, the joint can move freely again. For a less severe condition, this operation may be of temporary assistance by allowing a better range of motion and less pain.

If the arthritis is advanced, the joint at the base of the big toe can be fused (arthrodesis). This involves surgically stopping toe movement with pins, screws or a plate. Eventually the bones grow together or fuse. This stabilizes the inside of the foot and "freezes" the movement of the great toe. It also relieves the pain.

Complete or partial joint replacement with a prosthesis or implant is an option. Unlike the procedure for knees or hips, joint replacement surgery for arthritis of the great toe has not resulted in long-term success. For advanced arthritis of the great toe and long-term pain relief, fusion is considered the gold standard of treatment.

— Steven Kavros, D.P.M, Podiatry, Mayo Clinic, Rochester, Minn.