An Overview of Arthritis in Toes

toe arthritis

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Arthritis of the toes is caused by inflammation of toe joints, most typically the joint at the bottom of the big toe, otherwise called the metatarsophalangeal or MTP joint. It causes tenderness, swelling, stiffness and pain, and can manifest in all the toe joints. Past injuries, such as a broken or sprained toe, can eventually trigger arthritis, but arthritis can also develop as a result of general wear and tear on the joints, inflammation triggered by an autoimmune disease, or due to gout. Luckily, simple treatments can usually control symptoms. If those fail, several different surgical procedures are options.

Types and Causes

Several different types of arthritis can occur in the small joints of the toes, and while chronic inflammation is typically involved, the root causes vary.

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

  • Osteoarthritis, often referred to as "wear and tear" arthritis, is the most common type of arthritis. It is considered a non-inflammatory arthritis condition, although some inflammation is involved. 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. Osteoarthritis in the big toe has a special name called hallux rigidus. Obesity can increase the likelihood of developing arthritis, as increased weight puts more strain on joints. Women who wear tight, high-heeled shoes may be particularly at risk for foot issues that include pain and swelling of the big toe.
  • 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. It is considered "inflammatory arthritis," with inflammatory features such as warm and swollen joints, in addition to stiffness and pain. Because it is systemic, RA can also make you feel generally fatigued.
  • Gout, also known as gouty arthritis, is caused by the formation of uric acid crystals in a joint (most often the big toe). The uric acid triggers severe pain, redness, and tenderness. Certain factors, like genetics or kidney disorders, may predispose you to gout but diet, alcohol, and obesity can also contribute.
  • Psoriatic arthritis is an autoimmune disease linked to psoriasis. It can cause joint pain and stiffness as well as swelling of the fingers and toes, skin lesions, and nail deformity. Although psoriatic arthritis can occur on its own, it usually preceded by psoriasis.

Symptoms

Arthritis symptoms can be intermittent or persistent. Symptoms may come on suddenly or gradually. Typically, arthritis symptoms are aggravated with activity but subside with rest. Common symptoms include:

  • Pain and soreness at the base of the big toe: Usually, the pain is worse with standing or walking, but gets better once you are sitting. Pain often worsens when you are very active, and may take hours, or even days, to abate.
  • Swelling: Toe joints may feel "full," or you may have difficulty bending 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 as a result of damage to the normal cartilage surface of the joints. Toes may feel stiff and joints may lock. Often bone spurs will develop around the joint restricting the movement. 
  • Redness: Inflammation can lead to warmth and redness of affected joints. Some people develop pressure sores, calluses and blisters around affected toes.
  • Deformities: Malformations and knots of the toes are common. Since there is little soft tissue surrounding toe joints, even small abnormalities are easily detected. Bone spurs are a common cause of deformity around the arthritic toes. These abnormalities can lead to altered foot mechanics which in turn cause bunions, mallet toes, hammertoes, and other 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. Usually, when the swelling or bone spurs are no longer pressing on the nerve, the function of the nerve is likely to return to normal.
  • Clicking or popping sounds: Toe joints may make sounds as the cartilage that usually cushions two bones in a joint wears away. When bones rub together, they may crack.
Is it Osteoarthritis?
  • Osteoarthritis involves inflammation as a result of wear and tear of the joints.

  • Injury to a joint can cause OA later in life, as can the wear and tear of everyday life.

  • OA most commonly appears in the knees, hips, spine and hand.

  • Symptoms of OA are generally limited to the affected joints.

  • Pain and stiffness are common upon waking in the first hour of the day. Symptoms can be aggravated by activity and subside with rest.

Is it Rheumatoid Arthritis?
  • RA is an autoimmune disease in which the body attacks its own healthy tissue, causing inflammation.

  • Women are more prone to RA than men. Researchers believe there may be a genetic or hormonal component.

  • RA typically affects the hands, wrists, elbows, knees, ankles and feet. It usually affects the same joints in each foot.

  • Stiffness associated with RA tends to last longer than OA .

  • RA may involve a general fatigue.

Diagnosis

Your doctor will get a history of your condition and examine your foot to determine what type of arthritis is most likely to be causing your symptoms, the exact location of the arthritis and its severity.

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

The most common test used to detect toe arthritis 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) will aid your doctor in understanding the alignment of the foot.

Advanced imaging studies such as computed tomography (CT scans) and magnetic resonance imaging (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 simple steps. Rarely is it necessary to immediately jump to any type of surgical correction.

Ice and Heat Application

When inflammation is significant, ice packs can be beneficial. For those who don't appreciate ice, applying heat before activity can help joints loosen and bend without causing pain.

Footwear Modifications

Invest in high-quality shoes that include arch support, heel cups, thick soles, cushioning, and shock absorption. People with osteoarthritis in the feet may benefit from shoes with rocker soles, which have a thicker-than-normal sole with a curved heel. A shoe with this type of sole, common in athletic footwear, reduces pressure under the big toe joint by 12% in people with OA, research shows.

Orthotics and Inserts

Orthotics and inserts can help reposition the foot in a shoe, thereby relieving pressure on toes. There are many different types of inserts and orthotics, so you'll need to visit a podiatrist or foot and ankle specialist to determine which type is best for you. The simplest inserts, called accommodative inserts, do not correct a deformity but take pressure off of areas of the foot that are uncomfortable, thereby making normal activities bearable. Gel inserts are one example of inserts that cushion the foot, relieving discomfort.

Custom Orthotics

If accommodative inserts don't get results, semi-rigid and rigid insoles 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 can correct biomechanics at specific problematic joints while allowing as much normal foot movement as possible. Special rocker-bottom soles can be also be attached to shoes and help provide normal movement as you walk.

Lifestyle Modifications

Studies show that people with a higher body weight get arthritis at younger ages and are prone to more severe arthritis. Extra pounds put more force on your joints, leading to wear and tear, and can also cause more inflammation throughout the body. For the obese, a weight loss of just 10 percent of body weight can result in significant improvement in symptoms.

In addition to losing weight, physical therapy and specific exercises can help with foot pain. In general, regular moderate exercise helps maintain joint function while reducing pain and fatigue and relieving stiffness.  Talk with your physical therapist to determine what exercise would be best with the least wear and tear.

Anti-Inflammatory Medications

Oral anti-inflammatory medications can help relieve swelling and also alleviate discomfort associated with toe arthritis. Some people take these medications routinely, while others take them when arthritis flares up. Some studies show that turmeric, an herb from the ginger family, may have powerful anti-inflammatory properties that can help with arthritis pain. Always discuss any new medications or herbs with your doctor as there are always possible side effects.

Cortisone Injection

An injection of cortisone puts 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 flare up that does not settle down with other treatment, a cortisone injection can offer dramatic improvement.

Surgery

Surgery is seldom necessary for people with arthritis of the toes, but there are several surgical procedures available. The most common involves the removal of bone spurs that have formed around arthritic joints. This surgical procedure, called a cheilectomy, can be effective at removing the source of discomfort around a joint. In addition, by removing bone spurs, the movement of the joint is often improved. The downside is that the procedure leaves worn-out cartilage in place and 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 performed to stimulate bone growth across the joint so that the joint is permanently stiff, but painless.

A resection is performed to remove the entire joint.This essentially leaves a floppy joint that does have movement, but very little stability.

Surgery is generally considered a last resort in the treatment of toe arthritis because of its potential complications of ongoing discomfort and infection. While surgery is sometimes necessary, it is generally done only when other treatments have proven ineffective for quite some time.

A Word From Verywell

Arthritis in the toes can lead to pain while standing, walking, or engaging in sports or other activities. In most cases, symptoms can be relieved with a combination of orthotic shoes and inserts, physical therapy, anti-inflammatory medications and losing weight, when necessary. If these simple treatments don't work, more invasive treatment options can offer relief.

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Article Sources
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