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Toe Arthritis

The Condition

Hallux limitus/rigidus are terms used to describe degenerative arthritis of the great toe joint. Patients affected by these incapacitating conditions typically complain of stiffness, joint locking and pain.

The Treatment

Early detection, evaluation and treatment can lead to better results and more successful outcomes. Several conservative and surgical options are available to help manage these conditions. Symptomatic relief can be provided through the administration of oral anti-inflammatory medications as well as through the use of injectable forms. These medications can provide temporary relief of pain and discomfort. They can help to reduce inflammation and swelling and can be administered on an as-needed basis. Custom-made foot orthotics can also be fabricated to reduce joint motion and slow deformity progression.

Frequently Asked Questions

Arthritis can develop following acute blunt joint trauma or repeated small injuries to the feet over many years.
Early in its development, arthritis may appear as a slight swelling at the the joint and may not be painful. However, as the problem progresses, the lump becomes larger and more prominent. This causes pain, localized tenderness and limitation of motion, and results in permanent deformation.

Patients with arthritis of the great toe joint may have to alter the pattern in which they walk to compensate for the discomfort and lack of flexibility they experience. This change in propulsion can lead to knee, hip and back pain due to the formation of an unnatural stride.

Early diagnosis is key to prevent the problem from progressing. Custom made shoe orthotics can be fabricated to slow the deformity process. These devices work by improving stability and reducing inappropriate joint motion.
Conservative care can help to reduce pain and discomfort at the great toe joint. Wider shoes, custom made orthotics, joint exercises and medication are among the available options. Surgery is usually the best option for patients with a significant deformity, joint adaptation and arthritis.
Computer assisted digital plain film radiographic analysis of the skeletal deformity prior to surgery is key to procedure planning. This method involves taking digital x-ray images with the patient standing in the angle and base of gait to simulate the weight bearing position while walking. The bones and joints of the foot and ankle are then evaluated using computer assistance. Surgical procedures can be customized and tailor fit to the needs of the patient in order to correct and realign the foot.

Surgical treatment of great toe joint arthritis is usually addressed by joint fusion or joint replacement. The benefits of each procedure will be determined based upon your age and activity level. In some patients arthritis is due to bone spurs, which limit joint motion. The spurs can be removed in order to restore the normal anatomy and improve joint function.

The Cartiva Implant provides an entirely new category of great toe joint arthritis treatment for our patients. The implant possesses characteristics similar to those of native joint cartilage and implantation is not dependent upon age. The procedure can be performed in an outpatient setting and typically takes under 30 minutes. It also has the advantage of requiring a minimal amount of bone removal and requires a smaller incision which reduces tissue trauma. Patients can bear weight immediately on the surgical foot and often return to wearing regular shoes by the third postoperative week. The Cartiva implant can withstand the mechanical forces placed upon it with various forms of activity.
Joint replacement is available for individuals that live a less demanding lifestyle. The surgical procedure involves the removal of the arthritic joint surface(s) with the introduction of an implant that mimics the contour and anatomy of a healthy joint. These implants are typically constructed from various metals and composite polymer compounds. Once replaced, the joint functions in a similar fashion to a healthy joint. It should exhibit improved motion with a reduction in pain. Recovery is approximately 3 weeks. Patients are allowed to bear weight on the surgical foot immediately. Following recovery, patients can engage in light sporting activities such as golf, cycling and swimming, but are advised to avoid high impact activities.
Fusion of the great toe joint is also an option for patients with arthritis. This process involves careful preparation of the arthritic joint surfaces to remove any remaining cartilage. The two bones of the joint are then positioned to allow for adequate clearance of the toe when walking and running. The bones are maintained in this position while they heal as one solid unit. Stability during the healing process is achieved with internal fixation devices such as screws, a combination of a plate and screws, or pins. This type of procedure is a good option for younger and middle-aged individuals and for athletes. The fusion procedure can handle the force and impact associated with sports and running. Recovery requires a period of non-weight bearing on the surgical foot.

Before & After Photos

First Metatarsal Phalangeal Joint Replacement