Arthritis in the Big Toe

I Can’t Move My Big Toe

One of the more common complaints heard in our office setting is pain with any movement of the big toe joint.  And the most common underlying cause of pain in this area is arthritis.  Arthritis can occur in almost any of the joints in the foot, but the first metatarsal phalangeal joint (big toe joint) is one of the most often affected due to a variety of reasons.  Once arthritis is present within the big toe joint, it can be progressive and worsen with time if preventative measures aren’t taken.

The most common preventative measures for arthritis include cortisone injection therapy or custom orthotics. Early intervention with these conservative measures can often prevent patients from ending up in surgery.

However, when the arthritis becomes too painful in the big toe joint and/or preventative measures fail often times surgical intervention is the best solution. The surgery I often perform on patients with arthritic joints is a fusion (or arthrodesis).  A fusion of the joint is when the joint is essentially removed and it no longer allows motion.  The thought process behind this procedure is that the pain is occurring within a deformed joint, so if the joint is removed the pain will resolve.

The biggest part of the procedure that patients worry about is the fact their big toe will no longer bend up and down.  While this sounds like an undesirable result, the fact is that patients are still active and perform normal activities and exercise following this procedure.  When this procedure is discussed with patients, two things must be emphasized:  first, there will be relief of pain, and second, normal daily activities and exercise may be resumed once the arthrodesis heals.

The following case photos are from a patient who had undergone a bunion procedure six years prior, however started having pain two years following her procedure.  After a long discussion with the patient, it was concluded that an arthrodesis of her big toe joint was the best long term solution.  Patient is currently in the post-operative time frame and healing without complication.