• Dr. Jennifer Nicole Falk

How to Treat Big Toe Arthritis Without Surgery


Arthritis is most often associated with advanced age because the more we walk and the more mileage we put on our feet, the more wear and tear there is on the joints. Arthritis of the big toe joint can result from several other factors, as well, though, including foot structure, acute trauma, athletic injuries, and gout.


Limited motion of the big toe joint, also known as hallux limitus, is a progressive disorder that starts with flattening of the 1st metatarsal head, mild cartilage damage, and small bone spurs, and it ends with a stiff joint that has minimal to no available motion (aka hallux rigidus).


SYMPTOMS:

Pain is present around the big toe joint and occurs when the toe is bent upwards. Therefore, pain is exacerbated with extensive walking or running or when the joint is bent to its max, such as with squatting or while wearing high-heeled shoes. Swelling and redness may also occur, along with a dorsal bony prominence, which is the bony spur that can develop with arthritis.


Because similar symptoms can present with other pathologies, including infection and gout, it is important to seek medical advice if you are experiencing increasing pain, redness, and swelling around the big toe joint.


Check out my blog “Such A Pain in the Big Toe” to learn more about the different diagnoses that can cause pain around the big toe joint.


TREATMENT OPTIONS:

When the arthritis is severe enough (i.e. end stage) and/or conservative treatment options have been tried and failed, surgical treatment options can be considered. However, not all cases of hallux limitus or rigidus need to be treated with surgery.


Whether you are trying to avoid surgery, do not have time to go through the recovery process (which could be months), or are not healthy enough to undergo surgery, there are several alternative conservative treatment options available for the treatment of hallux limitus/rigidus.

Rest/Modification of Activities

During acute exacerbations of pain, you should avoid higher impact activities (e.g. walking, running, jumping) and switch to lower impact activities (e.g. swimming, biking) until symptoms improve.

Heat & Cold Therapies

Choosing whether to use heat or ice for your arthritic symptoms is dependent on the goal you are trying to achieve. For joint stiffness, heat therapy (e.g. heating pad, warm water soaks) will be more helpful because it will cause vasodilation (which increases blood flow to the area), relaxation, increased flexibility of the surrounding soft tissue structures, and improved joint motion. After exercising, cold therapy (e.g. ice pack, ice bath), tends to be more beneficial to cool down the area and decrease any swelling and inflammation that may have occurred.


Keep in mind, heat & cold treatments should be avoided if you have neuropathy (loss of sensation) or poor circulation, unless otherwise directed by your physician.


Anti-inflammatory Medications

Anti-inflammatory medications can also help with inflammation and swelling, which, in turn, help with pain; however, pain medications should not be used long-term.


Injections

Steroid– Steroid injections can help decrease inflammation and pain around the big toe joint, and they are very commonly used for arthritic joint pain across the body. The pain relief is usually only temporary (lasting weeks to months), and the use of steroids do have their potential side effects, so the injections should only be performed 3-4 times per year.

ProlotherapyProlotherapy (aka proliferation therapy) is a nonsurgical, serial injection of a dextrose solution that is injected into the affected area to stimulate an acute low-grade traumatic process, allowing the body to use its own inflammatory markers to aid in the body’s healing process naturally, thus regenerating and repairing damaged tissues, restoring joint stability, and improving pain. 


Supartz®Supartz® is a viscosupplement of sodium hyalonurate that is injected into painful, arthritic joints to help provide lubrication to the joint, in turn, increasing range of motion and decreasing pain. Injections of the pre-mixed solution are performed weekly for 3-5 weeks to help increase the time the medication is in the joint and to aid in the anti-inflammatory cascade within the affected joint. Pain relief may last several months.


Shoe gear

It is important to wear good, supportive shoe gear with a roomy toe box for both at-home and outdoors. Stiff-soled shoes and rocker-bottom shoes often work best for hallux limitus/rigidus. Avoid barefoot walking and use flip-flops and shoes with a significant heel.


The aim with many shoe gear choices is to find something that restricts movement of the big toe. If the shoe doesn't bend, the toe doesn't bend inside of it.


Orthotics

These are devices that go into your shoes to help cushion, support, and control abnormal motions of your feet. Oftentimes, a custom orthotic is better than an over-the-counter one for hallux limitus/rigidus because specific modifications can be made to a custom orthotic to either help increase the range of motion at the big toe joint or to prevent motion at the joint, depending on the severity, or stage, of the arthritis.


FINAL WORDS:

Arthritis of the big toe joint is a progressive disorder that can become very debilitating, especially for active persons. If pain or functional limitations are noted, it is important to seek help sooner, rather than later, to not only help with the symptoms, but to start treatment to help slow down the progression of the arthritis.


There are several treatment options that do not involve surgery and many are not invasive. If you go through this list, though, and are still having symptoms, it is then OK to discuss surgical intervention.


DISCLAIMER: The above information is meant for educational purposes only and should not be construed as medical advice. Please consult the doctor, or your own healthcare professional, should you have questions or concerns related to your health.


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