The big toe joint is very important in the gait cycle. The great toe is able to stabilize the arch in midstance and is critical for a functional gait and normal arch functioning. When the bone behind the big toe, the 1st metatarsal, is elevated, such as is seen in flatfeet, the range of motion of the great toe is decreased. An abnormal length of the first metatarsal bone can also cause a stiff big toe joint. The clinical name for this condition is Hallux Limitus.
Hallux Limitus is commonly seen in foot and ankle clinics. Pain is usually what prompts the patient to get the toe checked out. They may also notice a bump on top of their big toe. A decrease in the range of motion of the toe joint is usually encountered during physical examination as well as pain when the toe is pushed upwards (dorsiflexed) and/or pain when pressure is applied to the joint. X-ray often shows bone spurs around the joint and a decrease in joint space indicating wearing down of the cartilage. Hallux Limitus is basically the 'wear and tear' type of arthritis that people commonly get in their knees or hips.
So how do we treat it?
Treatment depends on the severity of the condition. Conservative treatment may include anti-inflammatory medications, orthotics, steroid injection to the joint, stiff soled shoes etc.. In mild cases of hallux limitus, these conservative treatments can be effective in decreasing pain and even improving motion in the case of orthotics.
When the joint degeneration is at a more advanced stage then surgical treatment options are more appropriate. A Cheilectomy is a procedure where the spur is removed. This is an effective procedure and often results in decreased pain and increased range of motion. Patients are usually in a boot for 2-3 weeks and then return to regular shoes. Ambulation is allowed day one. If the joint is degenerated beyond the point where a Cheilectomy can help, then a 'joint destructive procedure' such as an implant of fusion is then required. Fusion usually requires the use of screws and sometimes a plate and non-weightbearing (sometimes weightbearing on the heel is allowed) for 6-8 weeks following surgery.
If you have arthritis in your big toe joint, consider scheduling an appointment at Texas Foot and Ankle Specialists. We are conveniently located adjacent to the La Centerra outdoor shopping center across from Cinco Ranch High School in the Katy area of west Houston. We have convenient hours to accommodate a variety of schedules and offer same day appointments for those with pressing needs.