Big toe arthritis (hallux rigidus) is the most common form of foot arthritis, affecting around one in 40 people over the age of 50, with more women than men affected by the condition.
The big toe joint is called the hallux metatarsal phalangeal (MTP) joint. It connects the top of the first foot bone (metatarsal) with the base of the first toe bone (proximal phalanx). Arthritis is caused by wear to the cartilage that protects the joint and normally it is the top of the joint that is most affected.
Symptoms of big toe arthritis
Big toe arthritis causes pain in the big toe joint, particularly when pushing off to begin walking. The big toe joint may become swollen and difficult to move and may develop a bump like a bunion or bony spurs at the top of the joint. This can rub against footwear and become irritated. As the condition deteriorates, the big toe may become increasingly deformed and painful.
Causes of big toe arthritis
The precise causes of big toe arthritis aren’t completely understood but it is linked to excessive wear of the joint, which may have a genetic cause or be linked to abnormalities in the anatomy of the foot or previous injury to the big toe. Your big toe joints holds up to 100% of your weight every time you step and the pressure of this can cause the cartilage in the joint to wear away.
Diagnosis of big toe arthritis
If arthritis is suspected, an orthopaedic surgeon will assess the level of movement in the big toe joint and determine where the pain is located. X-rays may be taken to identify the extent of any joint degeneration or the development of bony spurs.
Treatment of big toe arthritis
Depending on how advanced the condition is and the severity of pain and loss of movement, you are likely to be offered non-surgical treatment initially.
Non-surgical: There are things you can do yourself to reduce the impact of big toe arthritis including avoiding wearing thin-soled or high-heeled shoes. Instead choose shoes with a stiff sole or curved sole or both to minimise joint pain. Ice packs, heat packs and anti-inflammatories may help to relieve pain and sometimes platelet-rich plasma injections may provide some relief.
Surgical: For more advanced big toe arthritis, surgery is normally recommended. In mild cases, a procedure called a chellectomy may be performed, which involves removing any bony spurs along with bone at the top of big toe joint to allow more room for the toe to bend when starting walking. Other small cuts may be made to change the position of the big toe.
Joint fusion surgery
Pros and cons
The conventional approach to treating more advanced big toe arthritis is with a surgical procedure called joint fusion or arthrodesis. This involves removing the damaged cartilage and then fusing the two bones of the toe together using screws and plates to hold the bones together until they grow together permanently. The advantage of this procedure is that it brings about a lasting reduction in pain. However, the disadvantage is that it restricts movement of the big toe. Once the joint is immobile you will not be able to push off with the big toe when you take a step. The foot and ankle will adapt to this change and you will still be able to lead an active life, however, the whole biomechanics of the foot and leg will be affected. Other possible complications include stiffness in neighbouring joints, delayed bone healing or irritation caused by the metal plate used in surgery.
Cartiva synthetic cartilage implant surgery
Cartiva synthetic cartilage implants are a revolutionary type of surgery that provide an alternative to joint fusion for advanced big toe arthritis. In a short 35-minute procedure, the damaged cartilage in your big toe joint is replaced with an innovative type of synthetic cartilage that behaves like natural cartilage.
Unlike conventional fusion surgery, Cartiva synthetic cartilage implants reduce pain while allowing your joint to continue moving in the way it is supposed to. The procedure is 40% faster than fusion surgery and recovery is also quicker with no need for casts or crutches and patients typically able to bear weight on their big toe immediately after surgery. Optimal recovery may take six to 12 months. Patients report a 97% reduction in pain almost six years after surgery.
Research study into Cartiva synthetic cartilage implant surgery
In a randomised controlled trial published in Foot Ankle International in May 2016, researchers assessed the safety and efficacy of synthetic cartilage implants compared to conventional joint fusion surgery. The study involved patients from 12 centres in Canada and the UK. Researchers concluded that pain relief and functional outcomes were equivalent in the two groups of patients, as was the need for any secondary surgical procedures. The study concluded that the synthetic implant is an excellent alternative for people who wish to retain full motion of their big toe joint.
If you are suffering from big toe arthritis, we can provide expert advice to support you to get back to an active and pain-free life, including explaining any surgical and non-surgical options.
Following the lockdown, Castle Orthopaedics is now re-open for virtual and face to face appointments at both Spire Nottingham Hospital and BMI The Park Hospital. Surgery is now also being scheduled once again, which means that injuries requiring surgery can be treated.
Our orthopaedic consultants each specialise in a particular area of orthopaedics, giving you added peace of mind that you are receiving expert medical advice and highly tailored treatment.
BMI The Park Hospital
Sherwood Lodge Drive Burntstump Country Park, Arnold NG5 8RX
Spire Nottingham Hospital
Tollerton Ln, Tollerton, Nottingham NG12 4GA