Arthritis affecting the big toe joint
The human foot is composed of 26 bones and 33 joints and like all joints over time due to continual use they become worn, do not work as well and can become deformed.
Osteoarthritis is the medical term given to the most common type of joint arthritis.
A joint just like a hinge on a door is made up of two opposing bone surfaces held together by ligaments and whose ends are covered in a material called cartilage. The joint is covered on the outside by the joint capsule.
Joints like to move freely and are lubricated with a substance called synovial fluid.
Osteoarthritis will affect all joints within the foot.
Hallux limitus and Hallux rigidus
When non-surgical treatment has failed to resolve the problem, these two conditions which affect the big toe joint are the most commonest we see here at The Yorkshire Foot Hospital.
Hallux limitus
When the quality and range of movement within the first metatarsophalangeal (big toe) joint is limited when the toe joint is bent backwards towards you.
What are the symptoms of Hallux limitus
This is usually a progressive condition, the degree of pain and discomfort is often dependent on how much weight and force is placed through the joint when you are standing, walking and participating in sport.
When we walk the big toe bends, takes your weight and helps to push you forward, with Hallux limitus when you are fully weight bearing this movement can be restricated as the joint temporarily locks, even though your toe may bend normally when sitting.
- Swelling over the top of the joint (exostosis)
- Stiffness and clicking within the joint
- Boney lump or spur developing on top of the joint
What causes Hallux limitus
- Repetitive trauma or a one-off injury eg stubbing toe
- Footwear eg Steel – toe capped boots
- Altered length of the first metatarsal
- Elevated first metatarsal head
- Gout attacks and inflammatory arthritis can contribute
Non-surgical Treatment for Hallux limitus
When patients initially present with this condition we prefer to treat non-surgically.
To confirm a diagnosis we are able to refer in-house at The Yorkshire Foot Hospital for an x-ray :
- Orthotics
- Physiotherapy eg joint mobilisation, exercises, ice
- Anti-inflammatory medication
- Footwear advice
If this first stage approach does not provide the correct level of relief :
- Steroid injection (cortisone)
- Ostenil injection (Hyaluronic acid to help reduce pain and stiffness in the treatment of osteoarthritis)
Surgical Treatment for Hallux limitus
There are a number of surgical treatments available at The Yorkshire Foot Hospital for the Hallux limitus.
Following consultation and a review of your x-rays, your Consultant Podiatric Surgeon will decide upon
the best treatment of choice based on a number of factors :
- Your overall general health, age and lifestyle
- Any underlying biomechanical issues
- Whether you wish to return quickly to sport
- The severity of the disease
Cheilectomy procedure
This procedure is generally undertaken to surgically treat mild to moderate joint arthritis on an Outpatient basis.
The aims of this procedure is to :
- Reduce pain and deformity
- Improve movement and alignment of the big toe joint
- Preserve the joint
- Improve footwear choice
- Return to normal lifestyle activities
Kessel – Bonney procedure
This procedure is generally undertaken to surgically treat moderate joint arthritis on an Outpatient basis.
The aims of this procedure is to :
- Reduce pain and deformity
- Improve movement and alignment of the big toe joint
- Preserve the joint
- Improve footwear choice
- Return to normal lifestyle activities
Hallux rigidus
Ongoing deterioration with further destruction of the articular cartilage as seen in Hallux limitus will over time lead to Hallux rigidus.
What are the symptoms of Hallux rigidus
The eventual destruction of joint cartilage and total loss of joint space caused by bone rubbing on bone leads to gross joint degeneration.
- Pain, swelling and stiffness over the top of the joint (exostosis)
- No bend within the joint
- Thickened boney lump on top of the joint
What causes Hallux rigidus
- Repetitive trauma or a one-off injury such as stubbing your toe
- Footwear eg Steel – toe capped boots
- Altered length of the first metatarsal
- Elevated first metatarsal head
- Gout attacks and inflammatory arthritis
- Joint infection
Non-surgical Treatment for Hallux rigidus
When patients initially present with this condition we prefer to treat non-surgically.
To confirm a diagnosis we shall refer to our Radiology Department here at The Yorkshire Foot Hospital for an x-ray :
- Orthotics with built in rocker sole
- Anti-inflammatory medication
- Footwear advice and modification
If this first stage approach does not provide the correct level of relief :
- Steroid injection (cortisone)
Surgical Treatment for Hallux rigidus
There are a number of surgical treatments available at The Yorkshire Foot Hospital for the Hallux rigidus.
Following consultation and a review of your x-rays, your Consultant Podiatric Surgeon
will decide upon the best treatment of choice based on a number of factors :
- Your overall general health, age and lifestyle
- Any underlying biomechanical issues
- Whether you wish to return quickly to sport
- The severity of the disease
Cheilectomy procedure
Kessel-Bonney procedure
Keller Excision Arthroplasty
This procedure is undertaken on an Outpatient basis.
The aims of this procedure are to:
- Reduce pain and deformity
- Improve movement and alignment of the big toe joint
- Improve footwear choice
- Return to normal lifestyle activities
Joint Fusion
This procedure is undertaken on an Outpatient basis.
The aims of this procedure are to:
- Reduce pain and deformity, by stopping any movement within the joint.
- Improve alignment of the big toe joint.
- Improve footwear choice.
- Return to normal lifestyle activities.
Cartiva Joint Implant
For those patients who present with arthritic joint changes and still retain a fairly good range of movement, the Cartiva is a new synthetic cartilage implant, which mimics the properties of natural cartilage.
The aims of this procedure are to:
- Reduce pain and deformity.
- Improve alignment of the big toe joint.
- Improve and restore mobility.
- Improve footwear choice.
- Return to normal lifestyle activities.
This procedure is undertaken on an Outpatient basis.
