Stiffness and Pain of the Great Toe Joint

Stiffness and Pain of the Great Toe Joint

The healthy joint is covered with artilage and looks white, smooth, slick.  Arthritic joints looks yellow or grayish, with thinning of the cartilage and even erosions.  Bone spurs develop around the edges of joint. Spurring further restricts the motion of the joint and contributes to more cartilage erosion.  The ability of the toe to bend up or down is affected.  Shoes and even walking barefoot are painful.

What does it feel like?

Painful, dull aching.  The pain can go up the foot, ankle and leg.  The mechanics of the great toe joint are important.   Shorter steps, even slight in toeing can occur unconsciously to avoid moving the painful joint.

How does this develop?

Arthritis can affect the bunion joint.  It results from wear and tear on the joint surface over time.  The condition may follow an injury or, in some cases, may develop without injury but develops by the way one walks.

It is uncertain about the true cause but it is evident that there are several things to suspect.  Often the first metatarsal is longer than the second metatarsal.  This is thought to cause the joint to press into the ground harder with every step. The result is jamming of the toe against the joint. Gradually the joint widens and develops spurs.  There can be a trauma such as kicking or dropping something on the foot.  It may damage the cartilage, which would not show up on an x-ray but will result in arthritis many years later.

Treatment:  what’s available?

Non-surgical

Treatment begins with medications to control, pain and  swelling, Some improvement is seen in about 10 days.   Shoes that have a stiff soles feel more comfortable. Cortisone injections have been given but usually give very short-lived relief. Orthoses help by improving your gait and can prevent the need for surgery.  Physical therapy to gently relieve the pain has helped many people.

Surgery

Surgery has come a long ways and varies greatly depending on the experience and training of the surgeon. Trimming of the spurs around the joint give temporary relief.  It is an old procedure that is no longer performed. Although it sounds like it would work, removing the spurs does not address the cause of the problem.

Osteotomies, or a cut in the bone, are preferred today.  They are performed on active people, and generally work very well to open the joint space or allow the remaining good cartilage to be used.   They are called joint preservation procedures.

Joint fusion is preferred by some surgeons to relieve pain.  To fuse the joint, a small amount of the joint is removed from both sides and joined.  It does remove the joint motion completely and eliminates the bone on bone arthritic pain.  Many patients are happy with the relief that they get.

Artificial joint replacement

Some surgeons favor replacing the joint with an artificial joint similar to what is done in the knee or hip.  One or both sides of the joint are removed and the space is filled with an implant.  There are many kinds of implants but they all act as spacers to eliminate pain and hopefully give some motion.  Generally implants are given to older patients who are also more sedentary.

What is new?  New cartilage! A healthier approach

Replacing the cartilage that is worn has been the goal for many years.  There is now a technique to grow new cartilage.  Dr. Young is trained and has experience with this technique.  It is more natural and having cartilage in the joint is preferable.  She is excited about the prospects of giving pain relief to people with arthritis in the great toe joint.

Make a consultation appointment with Dr. Debra E Young.  Board certified in foot and ankle surgery.  She is skilled at providing both new and time proven treatments for foot problems.

Debra E Young, DPM

773.327.0006

Debra E. Young, DPM, FACFAS

Diplomate, American Board of Podiatric Surgery

Fellow, American College of Foot and Ankle Surgeons

Fellow, American Professional  Wound Care Association