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Posted on: February 19 2024

Big Toe joint arthritis is a common condition we treat here at Cheltenham Podiatry. Also known as Hallux Rigidus  when the arthritis is so severe, there is no longer any joint movement available.  Otherwise known as Hallux limits when the arthritis is milder and there is still some joint movement. It is a condition characterised by the degeneration of cartilage in the metatarsophalangeal (MTP) joint at the base of the big toe. 

Here’s an overview ;

Symptoms and signs :

Aching pain with activity, particularly weight bearing. High heeled shoes will often aggravate pain due to impingement of the spurring at the joint line. There  maybe visible joint spurring or bumps at the joint line. 

Pathology:

  • Cartilage Degeneration: Similar to knee osteoarthritis, toe joint arthritis involves the breakdown of cartilage within the joint, leading to friction and wear between the bones.
  • Bone Spurs: Over time, the body may respond to stress and cartilage loss by forming bone spurs (osteophytes) around the joint, which can further limit movement and cause pain.
  • Joint Stiffness: As cartilage wears away and bone spurs develop, the joint becomes stiff and less flexible, resulting in difficulty with activities such as walking, bending, and pushing off during gait.

Classification:

  • Primary vs. Secondary Arthritis: Primary arthritis of the toe joint is typically associated with aging and wear-and-tear, while secondary arthritis may result from factors such as previous trauma, inflammatory conditions, or abnormal foot mechanics.
  • Stage of Disease: Toe joint arthritis can be classified based on the severity of symptoms and radiographic findings, ranging from mild stiffness- Hallux Limitus  to severe  functional impairment- Hallux Ridgidus. Pain is oft worse in the early staging. 

Management:

  • Conservative Treatments Include: 
  • Orthotic Devices: 3D printed Custom orthotic devices/ Semi Custom Orthotics   or Carbon Plates are often an important part of treatment protocol. . These offload the joint , and reduce pressure. 
  • Footwear Modification: Wearing shoes with a wide toe box and low heel, foreft rocker  and stiff sole  can reduce pressure on the toe joint and alleviate symptoms. This also helps to redistribute load away from the joint and thus reduce pain and inflammation. 
  • Activity Modification: Avoiding activities that exacerbate symptoms, such as running or wearing high heels, can help manage pain and preserve joint function.
  • Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may be prescribed to reduce pain and inflammation but are not a safe long term solution due ton adverse affects. 
  • Regeneration Therapies- Laser, otherwise known as photobiomodulation  uses red and infra red laser /led wavelengths to reduce inflammation and pain. Injection therapies as prolotherapy or PRP can be utilised via ultrasound guidance, to reduce inflammation and pain, and slow progression of disease. . 
  • Physical Therapy: Stretching exercises, joint mobilizations, and strengthening exercises for the muscles surrounding the toe joint can improve flexibility and stability.

Here at Cheltenham Podiatry we develop an individualised treatment plan. Often Combination therapies are utilised to provide long lasting results . We take into consideration patient’s symptoms, functional limitations, and treatment goals, with the aim of reducing pain, improving mobility, and optimizing quality of life. Early intervention and appropriate management can help slow the progression of toe joint arthritis and minimise its impact on daily activities. 

Biomechanical adjustment via appropriate footwear and orthotics/carbon plates are our 1st line of treatment. If pain persists we can add physical therapy and injection therapies as required. We aim to get you moving, and doing the things you love. 

Colò, G., Fusini, F., Samaila, E. M., Rava, A., Felli, L., Alessio-Mazzola, M., & Magnan, B. (2020). The efficacy of shoe modifications and foot orthoses in treating patients with hallux rigidus: a comprehensive review of literature. Acta bio-medica : Atenei Parmensis, 91(14-S), e2020016. https://doi.org/10.23750/abm.v91i14-S.10969

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