The foot is an amazing structure and made
up of 28 bones and more than 30 joints. Unfortunately, any of which can be affected by arthritis.
Arthritis, simply put, is the wear of the normal lining or cartilage of the joint and
can occur in any or multiple joints around the foot and ankle. In most people, there
is no definitive cause and probably relates to the enormous stresses across the joint
even when walking. For example, the big toe has a force equal to put twice your bodyweight
passing through it every step and it’s an extremely small joint. Add to that, the stresses
during exercise or when carrying extra weight and the forces can be extremely high and therefore
after years of repetitive impact, cartilage may eventually fail and develop arthritis.
In some people, however, a cause can be defined and may relate to an injury or another medical
problem such as a rheumatoid arthritis, gout or an infection in the joint. I would like to focus on big toe arthritis,
or hallux rigidus, which simply can be translated into big toe stiffness. Interestingly, the
wear of the cartilage can affect the whole joint but often only affects the upper part
of the joint. The most common problem is pain. This can range from occasional and only after
stressful impact exercise pain, to pain at rest or during the night. In others it only
occurs when they turn the big toe up as far as it will go. Stiffness is also a common
problem and can prevent the joint from moving upwards or less commonly downwards. A bony
bump or osteophyte may develop on top of the joint. This is your body’s natural response
to the worn joint and may rub on shoes. In some people, this is their only problem. Treatment can focus on several strategies.
The first question I often get asked is, is there anything that can be done to prevent
deterioration? Simply having a healthy lifestyle and keeping fit and active is important, wear
sensible shoes to prevent rubbing and irritation and keep at a healthy weight as more pressure
you put through an arthritic joint, the more pain you are likely to get. Once it is established,
the initial treatments are about managing the condition and include modifying your activities
or lifestyle, painkillers as you require or simply a rigid sole shoe that so that the
toe doesn’t bend and cause pain. If these simple measures fail, then an injection most
often of local anaesthetic and steroid may be helpful. Although, is rarely long-lasting.
For those that continue to have problems, there are several options available depending
on the pain and the extent of the arthritis. If the pain simply comes from the bony bump
or from the upper part of the joint, then removing these parts of the joint can improve
and even resolve the problem permanently, although some need further surgery. This can
either be done through an open approach or through small incisions depending on the nature
of the lump. If the whole joint is involved, then the procedure of choice is a fusion operation
which permanently stiffens the joint and can relieve pain in up to 95% of cases. Replacements
of the big toe are less commonly performed as they are yet to be proven to last, but
some bone preserving replacement procedures can be an option and can be discussed. Recovery from surgery requires two weeks of
elevation to allow the wounds to heal and to speed recovery. Depending on the surgery,
you may require a shoe for six weeks with follow-up x-rays. Swelling and minor pain
may go on for several months but should not stop one from returning to daily activities.