What is big toe arthritis?
This is a condition where the normal cartilage surface of the great toe joint becomes damaged so the joint does not move as smoothly as it should. This can lead to a painful, swollen and stiff big toe joint. The exact joint involved is the joint between the 1st metatarsal and the phalanx of the big toe.
What causes big toe arthritis?
It runs in families (genetic) but can also be a consequence of previous trauma or long-standing wear and tear from activities that increase the stress through the big toe joint.
What are the symptoms?
Patients complain of a painful swollen big toe with a reduced range of movement. Symptoms are exacerbated by activities such as running and squatting.
How is it diagnosed?
It is diagnosed by a detailed history of symptoms followed by an examination of the foot and ankle. The examination will look to identify swelling and tenderness localised to the big toe as well as assessing the restriction in range of movement. X-rays confirm the diagnosis and are also used to rule out and other pathology affecting the foot.
What is non-surgical management?
The main way to manage symptoms is to reduce the amount of stress going through the joint. This can be done with orthotics or rocker bottom shoes which help to offload the joint. Wider shoes that reduce the rubbing over the joint can also help. Weight loss and low impact exercise can also reduce mechanical load through the joint.
Medical treatment involves oral non-steroidal anti-inflammatory drugs (NSAIDs) and steroid injections into the joint to reduce the inflammation.
When is surgery considered?
Surgery is considered when all non-operative management has been tried and is no longer able to control symptoms day-to-day.
What does surgery involve?
In mild/moderate arthritis the symptoms can be controlled with a debridement (cheilectomy) of the joint which allows you to maintain range of movement of the big toe. The cheilectomy removes the spurs on the top of the joint to reduce symptoms but it does not remove all the arthritis so you there is a risk of arthritis progression, requiring further surgery in the future.
The most reliable option in more severe arthritis is a surgical fusion (arthrodesis) of the big toe joint. The restriction of movement means you will struggle with high heeled shoes of more than an inch. Some patients return to running sports but this is not alway possible and difficult to predict.
What are the risks of surgery?
General—General anaesthetic problems, scar irritation, infection or wound healing problems, nerve injury, deep venous thrombosis (DVT) and pulmonary embolism (PE).
Specific—Non healing of the fusion requiring further surgery and malposition of the toe requiring surgery to correct this.
What is the recovery following surgery?
Time frame
Activity
0–2 weeks
- One night in hospital
- Orthopaedic post op shoe, heel weight bearing
- Complete straight leg raise exercises and elevate limb when sitting
2–6 weeks
- Building up to weight bearing as tolerated in an orthopaedic shoe
- Intrinsic foot exercises
- Modalities to control swelling
- Incision mobilisation modalities
6–10 weeks
- Back into wide trainers
- Weight-bearing as tolerated
- Active and passive toe range of movement
- Incision mobilisation
12 weeks
- Return to good walking distances
12 months
- Full recovery from surgery
When can I return to work?
This is always dependent on the type of work you do and the recovery period can be extremely varied for individuals.
2 weeks
- Desk work
6 weeks
- Standing work
8 weeks or more
- Heavy lifting work
When can I drive?
Some postoperative pain medicines can affect your concentration, mood, coordination and reactions thereby reducing your ability to drive safely. You mustn’t return to driving whilst still taking any of these medications. Please check this link for further information https://www.vicroads.vic.gov.au/safety-and-road-rules/driver-safety/drugs-and-alcohol/medicines-and-road-safety
You can not return to driving when any foot involved in driving the car is restricted by an orthotic (post-op shoe, walking boot or plaster cast).
Car type
Operated foot
Automatic
Right—6 weeks. When you are fully weight-bearing in normal shoes
Left—Restrictions related to post anaesthetic and pain medications
Manual
Right/Left—6 weeks. When you are fully weight-bearing in normal shoes