How Osteoarthritis of the Big Toe Is Treated

Our feet provide support and strength to our legs and play a crucial role in movement and function. Without healthy foot joints, muscles, and tendons, the entire foundation of our legs becomes compromised.

The big toe, also referred to as the hallux, helps stabilize the entire foot and provides balance. But the hallux can be affected by several different conditions, the most common of which is osteoarthritis (OA), a type of arthritis that results when cartilage at the ends of bones wears down. OA of the big toe can cause pain, swelling, and joint stiffness, leading to movement problems.

This article discusses symptom management and treatment options for osteoarthritis of the big toe.

Signs and Symptoms

It's estimated that nearly 40% of people in the United States have some issue with their feet.

One of the most common ailments affecting the foot is the development of osteoarthritis of the first metatarsophalangeal (MTP) joint, where the big toe connects with the rest of the foot. This is often referred to as hallux rigidus.

Osteoarthritis of the big toe can range from mild to severe and can cause symptoms such as:

• Pain, often worse with activity
• Stiffness
• Swelling
• Loss of motion
• Altered gait (a change in the way you walk)

Osteoarthritis progression of the first MTP can also lead to the development of a bunion, also known as hallux valgus. This deformity causes a bony overgrowth on the side of the big toe. Often, the toe will start to turn toward the other toes, as opposed to being straight.

Causes and Diagnosis

While big toe and foot pain may be common, it is not always caused by the same factors or diseases. In fact there are many different causes of big toe pain. Getting to the underlying cause of the pain and discomfort is key when seeking appropriate and effective treatment.

However, the most common cause of big toe pain is in fact osteoarthritis. OA, often referred to as wear-and-tear arthritis, can develop after injury or lifelong activity. In osteoarthritis, the healthy joint space begins to narrow, and the cartilage which cushions both bony ends of a joint starts to wear down.

A healthcare provider will diagnose OA of the big toe by taking a thorough history, performing a physical exam, and taking an X-ray of the foot, which will show a narrowing of the joint space. Bone spurs (osteophytes), which are extra bony growths at the end of bones, can be seen on X-ray imaging as well.

Nonsurgical Treatment

Supportive Shoes and Orthotics

Shoe modifications and orthotics (custom-made shoe inserts) designed to limit MTP motion can be used to treat hallux rigidus. Wider toe boxes in shoes or rocker-bottomed shoes can help alleviate pressure from the big toe when walking and improve symptoms.

A podiatrist (foot doctor) may be able to customize orthotic shoes to an individual based on their personal needs.

Weight Loss

Because the feet and legs quite literally support a person's entire body weight, weight loss is an effective way to take extra pressure off of joints of the lower extremities.

Dietary modifications coupled with regular aerobic exercise is the most effective way to sustain long-term weight loss. While there are many diets, the Mediterranean diet, which emphasizes fruits, vegetables, healthy fats, whole grains, and less meat and dairy, and anti-inflammatory diets may be most helpful to people with OA.

Big Toe Exercises

One of the biggest challenges of OA when it occurs anywhere in the body is that the pain and discomfort usually end up limiting a person's range of motion, the measurement of movement of a joint.

However, the truth is that continued movement and exercise can actually help maintain near normal range of motion. Chronic stretching and exercise, when done properly, can help improve symptoms as well.

Medication

Over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil or Motrin (ibuprofen), can be used to help alleviate the discomfort, pain, and stiffness associated with OA of the big toe.

NSAIDs can also reduce inflammation within the first MTP joint, further improving symptoms.

Steroid Injections

If the first MTP joint is swollen and red, an intra-articular (into the joint space) cortisone injection may provide some relief in symptoms. Corticosteroids injected directly into the joint space will work to decrease the inflammation present, thus reducing swelling, redness, and associated pain.

Injections can be performed at the office of a podiatrist, orthopedist (specialist in the musculoskeletal system, including joints and bones) or rheumatologist (specialist in arthritis and other musculoskeletal conditions).

Surgical Treatment

Cheilectomy

For people with milder hallux rigidus (grades 1 or 2), a minimally invasive procedure known as a cheilectomy can be performed to relieve symptoms. The procedure involves the removal of dorsal osteophytes (bone spurs on the top part of the metatarsal head).

The procedure is considered joint sparing, because it maintains the range of motion of the joint. It's important to note that this procedure is considered a pain-relieving procedure, as it does not significantly improve the overall range of motion of the joint.

Arthrodesis

Arthrodesis of the first MTP is currently considered the gold standard of treatment for severe osteoarthritis.

Arthrodesis consists of fusing the bones that make up the MTP joint, essentially eliminating the joint itself. This is an effective pain-eliminating and deformity-correcting procedure, however, it comes at the cost of loss of range of motion. With the joint being fused, a person who has undergone this procedure will longer be able to bend or extend their big toe.

Arthroplasty

Arthroplasty is a surgical procedure that aims to restore the function of the toe joint.

Unlike some other surgical options, arthroplasty decreases the amount of pain a person experiences without losing any range of motion. In some cases, arthroplasty may actually increase a person's range of motion of the big toes.

Arthroplasty can either be done by remodeling the joint surfaces or by inserting an artificial joint (much like those seen in knee- and hip-replacement surgeries).

This surgery has evolved throughout history from the use of silicone implants to metal implants to synthetic cartilage implants.

Synthetic Cartilage Implant

Most recently, synthetic cartilage implants have been introduced as a potential treatment option for OA of the first MTP.

A synthetic implant is placed at the head of the first metatarsal, restoring a smooth joint surface.

Long-term studies are underway, but initial results are promising. Since only a small amount of bone is removed in order for the implant to be placed, near normal length of the toe itself is maintained, which is not always the case with other surgical options.

Prevention and Outlook

While there is no way to prevent osteoarthritis from developing, several things can be done to delay the onset or slow the progression. These include:

• Wearing supportive and proper footwear
• Performing stretching exercises
• Avoiding excessive strain or repetitive activities

Treating hallux rigidus is more effective if started when symptoms are mild. For people with severe symptoms and longstanding OA of the big toe, nonsurgical options may not be enough to provide adequate relief. More complex and sometimes limited surgical options may be needed.

Summary

Osteoarthritis of the big toe, also known as hallux rigidus, can cause pain, stiffness, and loss of joint mobility. Prognosis is good if symptoms are treated early.

There are numerous nonsurgical and surgical treatment options for hallux rigidus. Nonsurgical options include wearing supportive shoes and orthotics, big toe exercises, weight loss, steroidal medications, and NSAIDs. If necessary, surgical procedures like cheilectomy, arthrodesis, arthroplasty, and synthetic cartilage implants can be considered.

A Word From Verywell

If you are experiencing arthritic pain of the big toe, consult an orthopedic or arthritis specialist to discuss a diagnosis. Though symptoms may be minor, they can lead to severe pain and limited mobility. Several surgical and nonsurgical treatment options are available to provide symptom relief.