Degenerative Joint Disease – Osteoarthritis or Hallux Rigidus (Stiff Toe)
The most common site of arthritis in the foot is at the base of the big toe. This joint is called the metatarsophalangeal,or MTP joint. It's important because it has to bend every time you take a step. If the joint starts to stiffen, walking can become painful and difficult.
In the MTP joint, as in any joint, a smooth articular cartilage covers the ends of the bones. If wear-and-tear or injury damages the articular cartilage, the raw bone ends can rub together. A bone spur, or overgrowth, may develop on the top of the bone. This overgrowth can prevent the toe from bending as much as it needs to when you walk. The result is a stiff big toe, or hallux rigidus.
Hallux rigidus usually develops in adults between the ages of 30 and 60 years. No one knows why it appears in some people and not others. It may result from an injury to the toe that damages the articular cartilage or from differences in foot anatomy that increase stress on the joint.
Symptoms of Hallux Rigidus
In the early stages there is pain on motion (dorsiflexion and/or plantar flexion), often with limitation. Symptoms will be aggravated by exercise levels and footwear (either unsupportive shoes, shoes with an increased heel or short shoes causing back pressure into the joint). With time motion becomes more limited and shoes can show deformation of the upper around the joint. Diagnosis is primarily through clinical examination although x-rays help to grade the extent.
Treatment of Hallux Rigidus
Management of hallux rigidus can be either conservative or surgical. Conservative methods include the use of appropriate footwear, physiotherapy, orthotics, anti-inflammatory medication and in some instances Cortisone injections which can provide short term relief.
Surgical Treatment - Cheilectomy
This surgery is usually recommended when damage is mild or moderate. It involves removing the bone spurs as well as a portion of the foot bone, so the toe has more room to bend. The incision is made on the top of the foot. The toe and the operative site may remain swollen for several months after the operation, and you will have to wear a wooden-soled sandal for at least two weeks after the surgery. But most patients do experience long-term relief.
Fusing the bones together (arthrodesis) is often recommended when the damage to the cartilage is severe. The damaged cartilage is removed and pins, screws, or a plate are used to fix the joint in a permanent position. Gradually, the bones grow together. This type of surgery means that you will not be able to bend the toe at all. However, it is the most reliable way to reduce pain in these severe cases.
For the first six weeks after surgery, you will have to wear a post op shoe and possibly use crutches. You won't be able to wear high heels, and you may need to wear a shoe with a rocker-type sole.