Arthritis of the Toes

When your toes hurt, you might not suspect it to be arthritis; however, arthritis in the toes is more common than most people imagine.

What are the first signs of arthritis in the toes?

The first signs of arthritis in the toes begin with pain while walking, running, or other motions. You may also see signs of inflammation in the joint, like redness and swelling, and notice a decrease in the range of motion at the joint. At first, it may be very subtle, but the joint will get increasingly more painful and inflamed with time if treatment is delayed.

What causes toe arthritis or hallux limitus?

Arthritis occurs when a joint becomes inflamed and starts to deteriorate. More specifically, the cartilage, which helps the two bones in a joint glide easily past one another, starts to break down, and the two bones begin to grind against each other. The most common cause of toe arthritis or hallux limitus is due to the overall structure of the foot. People with flat feet tend to get them often because flat feet cause instability and malalignment to the entire foot structure, leading to arthritis. Another cause is injuries to the joint, such as a fracture or sprain. Even if the initial pain subsides, joint deterioration may continue if there was any damage to the cartilage when the injury occurred.

Is walking good for arthritis in the big toe?

Walking can irritate the joint further and worsen the symptoms of arthritis. This is because walking causes motion in the big toe joint, and when there is arthritis, any movement of that joint can lead to further damage to the cartilage and bone. However, even with arthritis, we all need to walk, so a way to delay the progression is to wear good, supportive shoes with stiff soles. These shoes can help stabilize the foot and minimize the motion that occurs at the big toe joint.

What are the best running shoes for big toe arthritis?

The best running shoes for big toe arthritis have a stiff sole and adequate arch support. A way to test that is by grabbing the two ends of the shoe - when you try to bend the shoe in half, the shoe should not bend easily. We want to stabilize the joint, and shoes with a stiff sole can act as a splint for the joint. Great running shoe brands that I recommend are Brooks, ASICS, and Hoka One. Hoka One shoes have an especially thick sole that will help to alleviate some of the pain while running.

What are my treatment options at home?

Treatment options at home include:

• Using a strap or padding device to minimize motion at the joint
• Taking over-the-counter, non-steroidal, anti-inflammatory medications
• Resting and icing the area when there is acute pain
• Using supportive shoes with a stiff sole

These at-home treatment options may help relieve some of the pain, especially when you first start noticing your symptoms. However, as arthritis starts to worsen, you may see that these at-home treatments may not work as well as they did previously.

When should I see a podiatrist for my big toe arthritis?

It would be best if you came to see a podiatrist when you notice increasing pain that affects your day-to-day activities despite trying treatment options at home. Some treatment options that we can offer as podiatrists include physical therapy, padding and strapping, custom foot orthoses, and some surgical options. In addition, we can evaluate you clinically and through x-rays to find you a treatment course that will work best to get you back on your feet.

When should I consider surgery for Hallux Limitus?

You should consider surgery for hallux limitus when you've tried other treatment modalities, such as physical therapy and custom foot orthoses, but still have debilitating pain that affects your daily activities. Surgery can offer a permanent solution to toe arthritis as it will alter the structure of the joint. For many patients suffering from hallux limitus, surgery remains the best treatment option to get relief from debilitating pain. However, the recovery process can take at least 6-8 weeks, which should always be considered when deciding to proceed with surgery.

What are my surgery options?

At Gotham Footcare, all conservative options are exhausted before considering surgery. However, several surgical procedures are evaluated if the pain and underlying issue is not resolved. We will evaluate your specific situation to see which procedure works best for you.

• Cheilectomy: A cheilectomy is the most common surgery for arthritis in the toes. It involves removing bone spurs that have formed around the joint, typically in the big toe. This surgery relieves discomfort and improves the toe’s movement in the joint.
• Arthrodesis/Fusion: This is another common procedure where the two bones creating the painful joint are fused. A combination of screws and plates is used for this procedure. Once the bone grows across the toe joint, pain is relieved significantly because the joint is no longer there. A disadvantage is that you will not be able to wear high heels after the bones are fused, but this procedure is more effective in reducing the pain long-term compared to the other procedures.
• Arthroplasty: With an arthroplasty, the surfaces of your existing joint are removed and replaced with an artificial joint - think like getting a knee replacement, but only on your toe joint. This procedure is most common for older patients who aren’t physically active, as there is a risk for implant failure after 10+ years.

Author: Dr. Mika Hirano, Foot & Ankle Surgeon at Gotham Footcare