Big Toe Arthritis

Your natural, healthy gait (movement) pattern relies on your big toe, called the hallux, to have good flexibility and mobility. Think of the actions your big toe takes when you walk - taking on pressure that it needs to adapt to and then bending as you push off the ground. If your big toe joint (called your metatarsophalangeal joint) becomes stiff and less mobile because of arthritic changes to the joint, it can significantly disrupt your gait and cause great pain.

There are two categories of big toe arthritis based on the level of stiffness in the joint:

• Hallux limitus means that the big toe is limited in its movement, but still retains some movement
• Hallux rigidus means that the joint is very stiff and unable to move, due to the damage incurred by the big toe joint
  

The symptoms of big toe arthritis depend on the cause and type of arthritis, but may include:

• Pain that increases with activity and weight-bearing, especially when bending the big toe
• Stiffness and loss of mobility and flexibility at the big toe joint
• Swelling at the big toe joint
• Big toe joint deformity, where the integrity of the joint and the involved bones degrade over time, with flexibility reducing as it does
• Bone spurs can also develop when the toe is repeatedly jammed, such as when walking on a stiff great toe joint
• Numbness or tingling: due to the presence of nerves in the area, a numbness or tingling sensation may also be felt around the big toe joint

Big toe arthritis can have a few causes that may alter the types of symptoms you experience and the progression of the disease. These include:

• Gout: gout is a type of inflammatory arthritis caused by the build-up of uric acid levels in the blood, which then crystallises and settles in the big toe joint. This can be extremely painful, and may cause damage to the joint, especially with repeated flares.
• Osteoarthritis: the ‘wear and tear’ arthritis where the cartilage breakdown is from mechanical factors (meaning from being used) over time.
• Rheumatoid arthritis: an autoimmune disease where the body’s own cells mistakenly attack the joints. Most cases of rheumatoid arthritis affect both feet and legs symmetrically in ‘flares’ or symptomatic episodes, and often other joints are also affected at the same time.‍
• Post-traumatic arthritis: arthritis can also occur following a previous big toe injury, such as a dislocation, fracture and even stubbing the toe. Specifically, an injured joint is about seven times more likely than an uninjured joint to become arthritic, even if the injury is properly treated.

Arthritis is a long-term condition, and as such, it requires a long-term focused approach with commitments to a healthier lifestyle, instead of a quick and temporary fix. To support your foot and big toe health, mobility and manage your painful symptoms, you may try:

• Continuing to meet your recommended exercise guidelines, while switching to low-impact exercises such walking and swimming, as well as other exercise that doesn’t overload the big toe joint
• Maintaining a healthy diet: consuming a healthy diet to nourish joints is important, as well as lowering the intake of purine-rich foods to help manage and prevent flares of gout
• Keeping your feet supported in good shoes both indoors and outdoors. A good shoe has the ability to add stability and support to your foot, optimising the way the big toe is loaded and helping you manage your symptoms. If you need recommendations on a new shoe that will be best for your feet, our podiatrists will gladly help and give you names and styles during your appointment.
• Using heat and ice therapy appropriately. Opt for ice when your big toe is swollen (acute symptoms), and heat when the joint feels tender and achy (chronic symptoms).
• Epsom salt bath: these may help in managing pain associated with joint arthritis
• Keeping up your physical therapy: if you’ve been prescribed foot strengthening or stretching exercises, continue to do these daily to best support your range of motion and foot health.
• For episodes of pain and swelling, non-steroidal anti-inflammatory medications (NSAIDs) may help to temporarily manage your symptoms.

Here at Matt Raden Podiatry, our trusted and experienced podiatrists listen to the concerns, goals and needs of our patients with big toe joint arthritis, and utilise a range of evidence-based treatment methods to help you get the best outcome for your ankle symptoms.

Every appointment starts with a comprehensive assessment to uncover the causes of your forefoot pain and joint stiffness, including whether any other factors could be at play, like a bone spur or involvement of the sesamoids located beneath the big toe joint. We’ll then create a tailored treatment plan based on the results. While the degenerative changes sustained in big toe joint arthritis are irreversible, there is a lot that can be done to help reduce your pain, improve your comfort, and optimise your mobility and quality of life. We may use:

• Orthotics (insoles): custom foot orthotics are a fantastic and helpful option for those with big toe joint arthritis. For structural hallux limitus, we can incorporate a first ray cut-out (special depression) in the orthotic to help improve the movement available at the big toe joint. For hallux rigidus where the big toe joint is completely stiff, we do the opposite, adding a special raised addition beneath the big toe joint that enables the joint and toe to make ground contact and offload excess pressure away from the joint.
• Footwear recommendations: your footwear plays a vital role in supporting your everyday comfort and health, as well as housing your orthotics, keeping your feet comfortable, and limiting further pain injury. This is why we make custom footwear recommendations and take the time to assess your footwear and answer all of your footwear-related questions.
• Exercise prescription: we may prescribe some foot exercises (depending on the severity and cause of your arthritis) to help promote foot (and overall big toe) strength and mobility.
• Surgery referral: in severe cases, we may refer you to an orthopaedic surgeon to discuss your surgical treatment options, or other options like cortisone injections