An Overview of Arthritis in Toes

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toe arthritis

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Arthritis does not affect the toe joints as commonly as some of the other joints in the body, but when it does, it can be a significant issue. For some people, every step they take is uncomfortable because of arthritis of the toes. Joint damage in this part of the body can limit your ability to perform athletic activities, and when severe, it may even limit comfortable walking.

When arthritis occurs in the toe joints, swelling, stiffness, and pain are all common characteristics of this condition. Often, simple treatments can be effective at controlling the symptoms associated with arthritis of the toes. It is unusual to require surgical intervention, although there are several surgical procedures that can be considered when simpler treatments are no longer effective at managing the symptoms of arthritis of the toes.

Symptoms

The typical symptoms of arthritis in the toes are the result of chronic inflammation around the small joints. There are many common symptoms of this condition.

Pain

Pain is the most common complaint of people who have arthritis of their toes. Usually, the pain is worse with activity and weight bearing, and relieved by rest. Pain is typically worse as activities progress and may take hours, or even days, to subside when the symptoms are exacerbated by activity.

Swelling

Swelling around the joints of the toes may give a sensation of fullness and difficulty bending at the joints. Even a small amount of extra fluid within these tiny joints can cause significant symptoms.

Restricted Movement

Range of motion of the joints of the toes can become restricted as a result of swelling, but also a result of damage to the normal cartilage surface of the joints. Often bone spurs will develop around the joint restricting the movement. When people have stiffness of the toes, activities become more difficult as the normal foot mechanics and movements will not function properly.

Redness

Redness is a sign of inflammation that can occur in a variety of conditions. In addition, because of deformities around an arthritic joint, people often develop pressure sores around their arthritic toes causing redness and even calluses and blisters to form.

Deformities

Deformities of the toes are common in people who develop arthritis. Since there is little soft tissue surrounding the joints of the toes, even small abnormalities are easily detected. Bone spurs are a common cause of deformity around the arthritic toes.

In addition, people with arthritis can develop altered mechanics of the feet causing common toe deformities including bunions, mallet toes, hammer toes, and other common toe deformities.

Numbness

Often when there is significant swelling or bone spurs around a toe joint, irritation of the nerves can occur leading to sensations of numbness, burning, or tingling. When these nerves are pressed on or irritated, they can function abnormally. Typically when the swelling or bone spurs are no longer pressing on the nerve, the function of the nerve is likely to return to normal.

Causes

There are several different types of arthritis that can occur in the joints of the toes, and the causes of these different types of arthritis can vary.

The most common types of arthritis that occur in the toes are osteoarthritis and rheumatoid arthritis.

Osteoarthritis is often referred to as "wear and tear" arthritis. It is the most common type of arthritis. This condition is characterized by the gradual wearing away of the smooth cartilage surface of the joints, often to a point where people develop typical end-stage bone-on-bone arthritis.

Rheumatoid arthritis is an autoimmune condition where people develop chronic inflammation of joints that can lead to the destruction of the normal tissues through an autoimmune response.

When people develop symptoms of toe arthritis, it is typically the result of inflammation around their joints. This inflammation can lead to typical symptoms (described below). Over time, joint damage can lead to restricted movement causing activities such as sports, or even normal walking, to become difficult. Osteoarthritis in the big toe (the great toe) has a special name called hallux rigidus.

This is the most common type of arthritis of the toes, although the treatments are similar to other types of arthritis in other toes. When arthritis occurs in one of the toes other than the big toe, it is called arthritis of the lesser toes. Arthritis in the toes can occur in both men and women and tends to increase in frequency as people get older.

Previous injuries, such as fractures and dislocations of the toes, can make it more likely that you will develop arthritis down the road. Increased body weight is also thought to be a risk factor for the development of arthritis in the toe joints.

Diagnosis

The diagnosis of toe arthritis begins with a history of your condition and examination of your foot. By learning more about your medical history, your doctor can gain information about what type of arthritis is most likely to be the cause of your symptoms. Examining the foot can help determine the specific location and extent of arthritis that has occurred.

It is important to assess the mechanics of the entire foot, not isolated to just the toes.

The midfoot, hindfoot, and ankle can also have significant effects on the movement and mechanics of the foot throughout the gait cycle.

The most commonly used test to detect arthritis in the toes is an X-ray of the foot. X-rays are helpful at determining the extent of joint damage and also the alignment of the bones in the foot. Sometimes obtaining special types of X-rays (including standing views where weight is applied while the X-ray is being obtained) can be helpful to best understand the alignment of the foot.

Advanced imaging studies such as CAT scans and MRIs are seldom needed. If there is a concern about a possible type of inflammatory arthritis, such as rheumatoid arthritis or gout, simple blood tests may be helpful to make these diagnoses.

Treatment

Treatment for arthritis of the toes almost always begins with some simple steps. Rarely is it necessary to immediately jump to invasive treatments. Attempting some simple treatments is almost always recommended before considering any type of surgical correction.

Footwear Modifications

Probably the most common way to relieve stress on the joints of the toes is with some simple footwear modifications. Altering the shoes that are worn to take pressure off of the toe joints is one of the simplest ways to relieve some of the stress from arthritis of the toes.

The use of shoes that have a more rigid sole can help to prevent excessive stress and bending forces on the toe joints. Generally, looking for shoes with a wide toe box and a rigid sole will help to relieve stress on the toe joints.

Anti-Inflammatory Medications

Oral anti-inflammatory medications can help to relieve swelling and also alleviate discomfort associated with toe arthritis. Some people take these medications routinely, while others will take them during episodes where their toe arthritis has flared up. Always discuss with your doctor before beginning any new medication as there are possible side effects of anti-inflammatory medications.

Ice and Heat Application

Occasionally when there is significant inflammation, application of ice can be beneficial, but most people do not like putting an ice pack on their toes. Applying heat before activity can help people feel as though the joints are loosened up and more easily bendable without causing pain to the joints.

Cortisone Injection

An injection of cortisone allows your doctor to place a powerful anti-inflammatory medication directly at the site of inflammation. While cortisone injections around the toes are sometimes uncomfortable, they can lead to very rapid and effective pain relief. The results tend not to be permanent, but often if you have a significant flareup that does not settle down with the aforementioned treatment steps, a cortisone injection can help dramatically.

Orthotics and Inserts

When the simple steps fail to adequately alleviate symptoms, usually the use of orthotics and inserts is the next step in treatment. There are many different inserts and appliances that are designed for people with a variety of toe conditions and deformities. Often determining which is the most appropriate requires a visit to a podiatrist or foot and ankle specialist.

The simplest inserts are called accommodative inserts. These are inserts that are not designed to necessarily correct the deformity, but rather to take pressure off of areas of the foot that are uncomfortable. These inserts are cushioning inserts that we will relieve stress on an area of discomfort. A highly recommended option are gel inserts as many people find these to be comfortable and to relieve pressure on uncomfortable areas of the foot.

These types of inserts do not correct mechanical deformities, but rather, make normal activities more comfortable by providing extra cushioning.

Custom Orthotics

If accommodative inserts are not sufficient, there are semi-rigid and rigid insoles that can correct deformities, redistribute weight, and correct mechanics of the foot. These types of orthotics generally need to be custom designed to accommodate your specific anatomy.

By providing a more rigid base, custom orthotics can take pressure off of arthritic joints by controlling how much motion occurs at a specific joint.

The advantage of a custom insert is that it will ensure the device is correcting mechanics at specific problematic joints well also allowing as much normal foot movement as possible. For people with more severe arthritis and difficulty with daily activities, special rocker-bottom soles can be attached to shoes and help provide more normal movement as you walk.

Is Surgery an Option?

Surgery is seldom necessary for people with arthritis of the toes, but there are several surgical procedures that can be considered. The most common surgery involves the removal of bone spurs that have formed around joints that have become arthritic. This surgical procedure, called a cheilectomy, can be effective at removing a source of discomfort around the joint. In addition, by removing bone spurs, the movement of the joint is often improved.

The downside of simply removing the bone spurs is that nothing is done to address the worn-out cartilage within the joints, and often the bone spurs can return down the road. A cheilectomy procedure is typically performed when there is arthritis of the big toe, and less commonly performed on the lesser toes of the foot. Surgical treatment of the lesser toes is generally restricted to either a surgical procedure called fusion or a resection.

Fusion is a surgical procedure performed to stimulate bone growth across the joint so that the joint is permanently stiff but painless. When bone grows across the joint, it no longer bends, and the joint is essentially gone. This can be helpful at relieving pain, but it does lead to symptoms of lack of mobility at that location. A resection is performed to remove the entire joint.

This essentially leaves a floppy joint that does have movement, but very little stability. In the lesser toes, this lack of stability is sometimes well-tolerated and resection can be an effective treatment at relieving pain while not causing significant stiffness.

One of the primary reasons that surgery is generally considered a last resort in the treatment of toe arthritis is that there are potential complications associated with surgical intervention. The most common problems associated with surgical treatment of the toes are ongoing symptoms of discomfort and infection. While surgery is sometimes necessary, it is generally only considered when simple treatments have been ineffective for quite some time.

A Word From Verywell

Arthritis can be commonly found in the joints of the forefoot. When arthritis occurs in the toes, symptoms can occur with activity including standing, walking, or athletic activities. Typically symptoms of arthritis of the toes can be well-tolerated with some simple treatments.

When simple treatments are ineffective, there are more invasive treatment options. However, most people find that with some noninvasive treatments including medications, activity modifications, and inserts for their shoes, they can manage the symptoms of toe arthritis without too much difficulty.

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