Big problems for the joints of the big toe

Big problems for the joints of the big toe.

Problems in the joints of the big toe are not fun, as many people know from personal experience. Red, inflamed or deformed joints can be unsightly. Even worse, however, is pain, and sometimes the risk of immobility, which accompanies joint problems of the big toe. Fortunately, you can take some simple steps to help relieve the pain and prevent it from slowing down.

Big toe 101

The big toe has two joints, but the most vulnerable to problems is the metatarsophalangeal joint (MTP). It connects the first long bone (metatarsal) in the forefoot to the first bone of the big toe (phalanx).

The

MTP joint is bent with each step it takes, so you can push and let the other leg advance. But poor MTP articulation gets beaten up during that process, supporting half of your body weight for a brief moment while pushing.

Osteoarthritis

A common consequence for the MTP joint is osteoarthritis, the wear of the cartilage at the end of the bones. It often appears from middle age. Without cartilage, the space between the bones decreases and the bones rub against each other. This can cause pain and lead to painful growths called osteophytes or bone spurs.

Osteoarthritis can also cause a loss of flexibility in the MTP joint, a condition known as hallux rigidus.

But MTP arthritis is not always painful. "Often, the arthritis of the big toe does not cause symptoms, we usually see people coming for other problems and then we see arthritis on an x-ray," says Dr. Christopher Chiodo, head of foot and ankle surgery at the Brigham and Women Hospital, affiliated to Harvard.

If MTP arthritis does not hurt, your doctor may recommend that you simply avoid wearing high heels, if you wear them, and instead wear stiff-soled shoes to reduce movement of the MTP joint.

The treatment comes if there is pain. In that case, Dr. Chiodo often prescribes a carbon fiber base plate to insert into the shoe and slow down the movement of the joint. "And some patients have relief with a shoe in the background," he adds.

Surgery to remove bone spurs, clean the arthritic MTP joint, or fuse bones is a last resort. Dr. Chiodo says that it may be necessary if

He has a daily pain that lasts more than three months.

The pain interferes with your daily activities.

and you have not responded to the non-surgical options.

Bunions

Family history and tight shoes with narrow finger boxes (such as high heels) can play a role in creating a bunion. If you have a bunion, the first metatarsal bone protrudes outward into the joint, causing the phalangeal bone to point inward toward the other fingers. "Compression of the fingers together for years weakens the ligaments that hold the toe in a straight position," explains Dr. Chiodo.

If the bunions do not hurt, avoid surgery, Dr. Chiodo recommends. "You can wear shoes with a wide box for your fingers or stretch your shoes to make room for the bulging MTP joint," he says. You'll also want to avoid wearing heels, which continue to compress your fingers together.

If the bunion hurts, the surgery aims to realign the bones of the foot so that the big toe is in a straight position. "Sometimes we have to cut the bone and restore it, and sometimes we have to fuse it," explains Dr. Chiodo. Afterwards, you may need to wear a special shoe or boot and avoid putting weight on your foot for six weeks.

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