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Arthritis at the base of the great toe (also known as hallux rigidus) is a wear-and-tear condition of the cartilage covering the ends of the two bones that comprise the joint.
The cartilage of the joint can be degraded, or worn down, over time leading to arthritis. There can be several possible reasons behind this kind of degradation, including autoimmune disorders and genetics.
This article looks at hallux rigidus, its causes, and the ways in which it can be managed so that you can lead a pain-free life.
How Common Is Big Toe Arthritis?
Nearly 40% of all the people in the United States suffer from some kind of foot disorder, with big toe arthritis affecting 2.5% of all the patients that are above the age of 50 years. (1)
Causes of Big Toe Arthritis
The primary causes of big toe arthritis include:
1. Degenerative osteoarthritis
The most common cause of great toe arthritis is degenerative osteoarthritis, which occurs naturally to some degree as you age.
In this form, the arthritis progresses through several stages from mild inflammation to complete cartilage and joint destruction with the formation of bone spurs across the joint. Unlike arthritis of other joints such as the knee or hip, big toe arthritis can begin in your 30s and 40s.
2. Inflammatory disorders
Inflammatory conditions such as rheumatoid arthritis can also lead to big toe arthritis, often occurring bilaterally (involving both feet).
3. Foot trauma or injuries
Patients who have sustained a focal injury (called an osteochondral lesion) to a portion of the cartilage of the great toe joint, specifically athletes, may also go on to develop arthritis of this joint. This injury may have happened in their teens and twenties, unbeknownst to the patient, but the arthritis may present much later in life.
Great toe fracture or other higher-energy trauma may also damage the cartilage and cause great toe arthritis in the long run.
4. Gout arthropathy or podagra
Another common cause of big toe arthritis is gout arthropathy. (2) Gout is characterized by the excessive production and deposition of uric acid crystals into the joints. One of the most common sites of gouty arthritis is the great toe. This condition is also known as podagra.
An episode of gouty arthritis will present very acutely, or suddenly, with severe pain, redness, swelling, and warmth around the joint.
With each attack, the joint cartilage is damaged, predisposing patients to irreversible arthritis in the long run. This is why patients with gout require treatment to avoid the number of recurrent episodes over their lifetime.
Symptoms of Big Toe Arthritis
The symptoms of big toe arthritis vary depending upon the stage of the disorder as they tend to be mild during the initial stages and worsen as time goes by. Big toe arthritis can be divided into the following phases:
1. Preliminary phase
Big toe arthritis is characterized initially by pain with the bending motion of the great toe joint. Patients may initially notice a dull pain with walking or running.
At the early stages, pain may be present only at the initiation of movement and then increases as the joint “warms” up. With progression, pain is present throughout the activity. Slight warmth and swelling may also be present following activity.
2. Intermediate phase
Eventually, the range of motion of the joint will become restricted as cartilage is lost. This can be so severe in advanced stages that the joint essentially becomes locked.
Cold, humid weather conditions tend to aggravate the pain and stiffness in the joint. Interestingly, some patients may notice that their pain improves at this stage as the lack of joint motion becomes protective.
3. Advanced phase
Finally, as the condition worsens, the size of the great toe may appear to change. The presence of bone spurs and calcifications around the joint causes the joint to appear bulkier. The increase in size can then lead to pain in shoe wear due to compression around the joint.
Some patients may also begin to experience burning sensation, numbness, or tingling around the toe due to the compression of the skin nerves between bone spurs and shoe wear.
Diagnosing Big Toe Arthritis
The diagnosis of big toe arthritis can only definitively be made with standing X-rays of the feet.
X-rays do not show the cartilage but will demonstrate narrowing or loss of the joint space (due to loss of the cartilage), bone spurs, and erosions of the bone due to inflammatory conditions, which are all indicative of arthritis.
Signs, symptoms, and a history and physical exam will aid in the diagnosis and also in understanding the cause. Occasionally, your physician may order an MRI to specifically look at the cartilage if the changes on the X-ray are mild, to determine if there are small injuries to the cartilage and also to assess the degree of inflammation around the joint.
Self-Care Measures for Big Toe Arthritis
Once a diagnosis is made, there are several nonoperative remedies to help manage the symptoms of big toe arthritis. (3) Unfortunately, the condition is irreversible.
- Proper footwear is key. (4) Wide shoes with uppers that are soft and smooth will help alleviate the symptoms from the tight, rigid compression around the joint. Furthermore, because excessive motion of the joint causes pain, shoes should have a semirigid or rigid sole to minimize the amount of bend at the forefoot. A special type of orthotic, called Morton’s extension, can be purchased and placed within the shoe. This is a very thin carbon fiber plate that runs beneath the big toe and acts to limit motion of the joint with walking. This can also be incorporated into a full custom orthotic that can be ordered by your physician.
- Oral anti-inflammatories are very effective at managing the symptoms of big toe arthritis. This can take the form of over-the-counter medications, such as ibuprofen or naproxen, or naturopathic treatments such as turmeric. (5) Turmeric may be taken in capsule form or by adding the spice to teas or food in regular, daily amounts. Usage of any anti-inflammatories should be approved by your physician.
- A warm foot soak may provide relief. Some patients may find relief soaking the foot in a warm bath before activity to help loosen the joint. After activity, pain and swelling may be improved with a short period of icing or a cooling ice bath. Be sure never to place ice directly on the skin.
- Lifestyle modifications, including maintaining a healthy weight and performing low-impact exercises such as biking or swimming will generally decrease the forces across the joint and may improve symptoms. Generally, physical therapy or excessive direct range of motion of the joint should be avoided as this will only aggravate the symptoms.
Prescription Treatment for Severe Big Toe Arthritis
If proper self-care and home treatment fail to provide adequate relief, your physician may progress to other forms of treatment: (6)
- The first is typically a prescription-strength anti-inflammatory, which can be quite effective at mitigating symptoms.
- If anti-inflammatories fail, cortisone injections used occasionally (typically no more than three times per year) can provide long-term relief depending on the stage.
- Finally, surgery may be required and can range from bone spur removal (cheilectomy), great toe joint fusion (arthrodesis), or even replacement of the great toe joint (arthroplasty).
Key Preventive Measures
Here are some useful measures that can help prevent or delay the onset of big toe arthritis:
1. Maintain a healthy weight
Your entire body weight falls on your feet while standing, which puts a lot of strain on your toe joints. The heavier you are, the more stress your joints will have to endure.
Under such conditions, even simple but regular activities such as walking can cause wear and tear in your joints, which can worsen over time. Maintaining a healthy weight is therefore very important to minimize joint degeneration.
The best way to stay fit and reach your weight goals involves a 2-part approach:
- Eating a nutritious, well-balanced diet
- Burning the extra calories through some form of physical activity done for about 30 minutes daily
2. Keep your blood sugar in check
This is quite important for those struggling with diabetes as it has been shown that increased blood sugar can lead to cartilage damage. (7)
3. Manage your gout effectively
If gout is present, preventing the number of attacks is key to preventing or delaying the formation of big toe arthritis. This is obtained by dietary management and limiting your intake of purine-rich foods.
Proper medical management of your gout, which may include daily medications such as allopurinol or episodic medications such as colchicine or steroids, will also help limit the amount of joint destruction.
ALSO READ: Home Remedies and Self-Care Tips for Gout
Big toe arthritis often begins in the third decade of life and is irreversible. Its diagnosis can be made using X-rays and MRI. Your doctor will also assess your medical history.
There are some important nonsurgical remedies such as orthotics, OTC analgesics, and lifestyle modifications that are very helpful in managing the symptoms if they are mild. If such self-care measures fail, your doctor may suggest some prescription anti-inflammatories and curative surgical options.