Degenerative arthritis of the first metatarsal phalangeal joint, also referred to as the great toe joint, can be a very painful and incapacitating condition. Arthritis of this joint can lead to limitation of walking and running based activities. Patients affected by this condition typically complain of stiffness, joint locking and pain. Patients may have to alter the pattern in which they walk to compensate for the discomfort and lack of joint flexibility they experience. This change in propulsion can lead to knee, hip and back pain due to the formation of an unnatural stride.
Several options are available to help manage this condition. Symptomatic relief can be provided through the administration of oral anti-inflammatory medications as well as through the use of injectable forms. These medications can provide temporary relief of pain and discomfort. They can help to reduce inflammation and swelling and can be administered on an as needed basis. Custom insoles (foot orthotics) can also be fabricated with special modifications to further reduce motion at the painful joint in an attempt to reduce pain.
In cases of severe joint arthritis surgical options are often necessary. Several procedures are available to help reduce pain and improve motion to allow for a more natural walking pattern. In some patients the arthritis presents as bone spurs, which surround and limit proper joint function. The spurs can be removed in order restore the normal anatomy and improve joint motion.
Joint replacement is available for those of us that have great toe arthritis and live a less demanding lifestyle. Post-procedure, individuals can engage in light sporting activities such as golf, cycling and swimming. Patients are advised to avoid high impact activities affecting the lower extremity. The surgical procedure involves the removal of the joint surface(s) and introduction of implants, which match the contour and anatomy of healthy joints. These implants are typically constructed from various metals and composite polymer compounds. Once replaced, the joint functions in a similar fashion to a healthy joint and should exhibit improved motion and a reduction in pain.
Fusion of the great toe joint is also an option for patients that are not candidates for joint replacement. This process involves careful preparation of the arthritic joint surfaces to remove any remaining cartilage. The two bones of the joint are then positioned to allow for adequate clearance of the toe when walking and running. The bones are maintained in this position while they heal as one solid unit. Stability during the healing process is achieved with internal fixation devices such as screws, a combination of a plate and screws, or pins. This type of procedure is a good option for younger and middle-aged individuals and for athletes. The fusion procedure can handle the force and impact associated with sports and running.
These and other care options can be discussed in further detail with your podiatric surgeon. Patient age and the severity of the arthritis tend to dictate the appropriate course of treatment.
