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Big Toe (Hallux Osteoarthritis)

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Hallux osteoarthritis literally means degenerative change of the big toe. This common condition is often caused by disability and substantial pain. Painful big toe joints that have a reduced movement range will affect the manner in which you walk, which is often the main source of pain outside of the foot, as well as knee and ankle pain.

Arthritis of the big toe joint is often attributed to trauma and biomechanics. It is usually caused over many years by repetitive wear and tear. Occasionally people might end up remembering an incident where they believe the joint pain arose from.

Hallux osteoarthritis is typically presented as pain in the big toe along with reduced range of mobility. The toe can appear swollen and walking can be painful. The patient may limp, or prefer to walk on the heel of their foot.

Hallux Osteoarthritis Anatomy

Hallux Osteoarthritis anatomy image

The joint that lies at the base part of the big toe is often known as the metatarsophalangeal joint. Just like any other joint within the body, it is covered with an articular cartilage, which is a slick, shiny covering that lies on the end part of the bone. If that material becomes injured, it can begin degenerating. The articular surface will end up wearing away until the raw bone is rubbing against the other bone.

When this happens, the body tries to lay down extra bone to protect the inflamed/rubbing bone, and may form new bone called osteophytes or bone spurs. These osteophytes will end up restricting the motion within the joint, especially when it comes to being able to bend the big toe upward whenever the foot moves.

Hallux Osteoarthritis xray image

How To Treat Hallux Osteoarthritis

1. Steroid Injections

When the soft tissues are inflamed around the joint and arthritis is only minimal, manipulation under a general anaesthetic and steroids injected into the joint can help to relieve any symptoms you are experiencing and delay the need for surgery. Repeated injections are contraindicated in preserved joints, as this can lead to an increased rate of degeneration for the articulating cartilage.

2. Physiotherapy / Osteopathy / Podiatric Treatment

A series of these treatments uses manipulation, mobilisation and pain relief techniques to help provide the individual with the benefits needed to make it through the day. Once range of mobility is restored to the big toe, often symptoms of inflammation will reduce. Your Rehab My Patient therapist will also prescribe exercises that will improve mobility of the big toe. Heat (and/or ice) can also be of benefit.

Hallux Osteoarthritis treatment image 1
Hallux Osteoarthritis treatment image 2

3. Orthotics

Using orthotics can help to play a key role in forcing redistribution. They can be attempted from the early stages when pain begins and mobility in the joint becomes minimal.

4. Surgery

The main criteria for managing the condition with pain relief is surgery. Osteoarthritis within the big toe joint is often presented as a bony prominence that is painful. It rubs along the shoe with a painful restricted motion for the big toe joint. Most of the time, people will present with a stiffness, but not discomfort. Surgery indications will depend largely on the extent of the symptoms and arthritis.

Common types of surgery are Keller arthroplasty, Cheilectomy, joint implant surgery, decompressive osteotomy and big toe arthrodesis.

Tips

  • Adults between the ages of 50 and 70 are often most prone to developing this condition.
  • The condition may occur from the result of a previous injury from playing sports.
  • If you have a family history of arthritis you are more likely to develop big toe arthritis.
  • Since the condition develops over the course of time, you might not realize there is a problem at first.
  • When playing sports, make sure to have the proper equipment in place to protect your feet.
  • Gout and rheumatoid arthritis are known contributors to the development of big toe OA.
  • Contrast bathing can be very useful at reducing the inflammation in the foot/toe. An ice pack or heat pack can be used, or placing the foot in a container of water. Alternatively, in a spa, hot water and cold water can be alternated. Your therapist will advise you how long to use the ice and heat for.