Big Toe Arthritis (Hallux Rigidus)
This is wear and tear of the cartilage of the main joint of the big toe (Metatarsophalangeal MTP joint).
How is it caused?
What are the symptoms?
Pain, stiffness and swelling (Arthritis) on the top of the toe are the typical symptoms. Many patients subconsciously manage the pain by changing their gait to avoid loading through the big toe joint. This can cause secondary symptoms of pain on the outside of their foot. Over time, the arthritis tends to get worse. Treated early, there may be sufficient good cartilage remaining to preserve the joint.
How is it diagnosed?
How is it treated?
What can I do?
Anti-inflammatory medication and insoles can help in the early stages.
If the pain is not resolved by simple measures, then surgery can be considered.
Non-Surgical Treatment
Analysis of your gait by a specialist (podiatrist or orthotist), can help to redistribute the load through your foot by providing you with bespoke insoles.
An injection with steroids or hyaluronic acid can ease pain, reduce the inflammation and help to preserve the remaining joint cartilage.
Laser therapy may also help with inflammation.
Surgical Options
If there is localized damage to the cartilage surface, there are techniques to help stimulate the cartilage.
‘Key Hole’ arthroscopic surgery is used to assess if the underlying joint surface can be stimulated using a technique known as ‘Nanofracture’.
Shaving (Cheilectomy) – is an operation to remove a bony lump on the top of the main joint of the big toe which can be done arthroscopically, using Minimally Invasive Surgery (MIS).
Joint Replacement (Arthroplasty) – for those with more advanced arthritis it may be required to ‘cushion the joint’ (interposition’ arthroplasty) or to replace part (hemiarthroplasty), or all (total arthroplasty), of the joint surface.
Fusion (Arthrodesis) – In certain cases (such as in diabetic patients) it may be preferable to fuse the big joint. If this is appropriate, then the procedure can be performed using MIS.
