The foot is an amazing structure and made up of 28 bones and more than 30 joints. Unfortunately,
any of which can be affected by arthritis. Arthritis, simply put, is the wear of the
normal lining or cartilage of the joint and can occur in any or multiple joints around
the foot and ankle. In most people, there is no definitive cause and probably relates
to the enormous stresses across the joint even when walking. For example, the big toe
has a force equal to put twice your bodyweight passing through it every step and it's an
extremely small joint. Add to that, the stresses during exercise or when carrying extra weight
and the forces can be extremely high and therefore after years of repetitive impact, cartilage
may eventually fail and develop arthritis. In some people, however, a cause can be defined
and may relate to an injury or another medical problem such as a rheumatoid arthritis, gout
or an infection in the joint.
I would like to focus on big toe arthritis, or hallux rigidus, which simply can be translated
into big toe stiffness. Interestingly, the wear of the cartilage can affect the whole
joint but often only affects the upper part of the joint. The most common problem is pain.
This can range from occasional and only after stressful impact exercise pain, to pain at
rest or during the night. In others it only occurs when they turn the big toe up as far
as it will go. Stiffness is also a common problem and can prevent the joint from moving
upwards or less commonly downwards. A bony bump or osteophyte may develop on top of the
joint. This is your body's natural response to the worn joint and may rub on shoes. In
some people, this is their only problem.
Treatment can focus on several strategies. The first question I often get asked is, is
there anything that can be done to prevent deterioration? Simply having a healthy lifestyle
and keeping fit and active is important, wear sensible shoes to prevent rubbing and irritation
and keep at a healthy weight as more pressure you put through an arthritic joint, the more
pain you are likely to get. Once it is established, the initial treatments are about managing
the condition and include modifying your activities or lifestyle, painkillers as you require or
simply a rigid sole shoe that so that the toe doesn't bend and cause pain. If these
simple measures fail, then an injection most often of local anaesthetic and steroid may
be helpful. Although, is rarely long-lasting. For those that continue to have problems,
there are several options available depending on the pain and the extent of the arthritis.
If the pain simply comes from the bony bump or from the upper part of the joint, then
removing these parts of the joint can improve and even resolve the problem permanently,
although some need further surgery. This can either be done through an open approach or
through small incisions depending on the nature of the lump. If the whole joint is involved,
then the procedure of choice is a fusion operation which permanently stiffens the joint and can
relieve pain in up to 95% of cases. Replacements of the big toe are less commonly performed
as they are yet to be proven to last, but some bone preserving replacement procedures
can be an option and can be discussed.
Recovery from surgery requires two weeks of elevation to allow the wounds to heal and
to speed recovery. Depending on the surgery, you may require a shoe for six weeks with
follow-up x-rays. Swelling and minor pain may go on for several months but should not
stop one from returning to daily activities.