Dr. Meredith Warner is an orthopedic surgeon and founder of Well Theory, your resource for maintaining and promoting full body wellness and improving function as you age.
The MTP joint or the metatarsophalangeal is on of the most common sites of arthritis in the foot. Located at the base of the big toe, this joint is important because it must bend every time that you take a step. Once arthritis sets in and the joint begins to stiffen, walking can become particularly painful.
When two bones meet and move together, that is called a joint. The ends of the bones are coated in cartilage which is very smooth and allows motion. Eventually, this may cause reactive bone spurs to develop. In hallux rigidus a prominent spur will develop in the top of the bone and the joint. This spur prevents the toe from bending as much as it needs to when you walk; resulting in hallux rigidus or a stiff big toe.
Hallux rigidus generally develops in adults between the ages of 30 and 60 years old. While there doesn’t seem to be any scientific reason as to why it affects some individuals and not others, it is thought to result from differences in foot anatomy that increase stress on the joint. In addition, some specific injuries to the toe can damage the articular cartilage and cause hallux rigidus.
- Swelling around the great toe joint
- Pain in the joint when active, especially when walking
- A bump that develops on top of the foot at the joint
- Stiffness in the great toe coupled with the inability to bend it up or down
- Hallux rigidus often looks like a bunion
If you begin to find it difficult to bend your big toe up and down or you are walking on the outside of your foot as a result of the pain in the toe, please contact us right away. Hallux rigidus is easier to treat when the condition is caught in the early stages of development. If you wait until the development of bone spurs that are visible in the form of bony bump on the top of your foot then the condition will be far more difficult to treat. However, it is still treatable with the right skills and technology.
Your doctor should examine your foot and will look for any evidence of bone spurs. She will also check the toe for mobility and to see exactly how much movement can be achieved without pain. X-rays will pinpoint the size and location of any bone spurs, as well as, the progression of any degeneration within the joint space and cartilage. X-rays are helpful to determine the overall architecture of the foot and to plan surgery or treatment.
Anti-inflammatory medications may assist in reducing swelling and easing the pain of hallux rigidus. Applying ice packs or taking hot and cold baths may also control the symptoms and reduce swelling and inflammation for short periods of time. Your physician will likely recommend wearing a stiff-soled shoe with a rocker or roller bottom design or even a shoe with a steel shank or metal brace. This type of design supports the foot while walking and also reduces the amount of bend in the big toe. Taping often helps. In addition, physical therapy can be very successful in treating this condition.
Arthrodesis: Fusing the bones is recommended when there is severe damage to the cartilage. The damaged cartilage is removed and screws, pins or a plate are then used to fix the joint in a permanent position. The bones grow together over time. While this procedure has traditionally been the most reliable in terms of reducing pain, it is important to note that you will not be able to bend your big toe at all. Fusion should be a last resort procedure only.
Cheilectomy: This surgery is recommended for patients with mild to moderate damage. This procedure removes the bones spurs and a portion of the foot bone, so that the big toe has more room to bend. An incision is made at the top of the foot. It is important to note that while most patients do experience long-term pain relief after the surgery, the toe and the operative site may remain fairly swollen for several months post-op. When one has a cheilectomy it is expected that another treatment will eventually follow.
Arthroplasty: This procedure is best suited for patients who do not place many high impact functional demands on the feet. Arthroplasty is a joint replacement surgery in which the joint surfaces are removed and an artificial joint is then implanted. This procedure may relieve pain and preserve some joint motion. It is possible to remove one side of the joint or both sides. The surgery is successful for pain relief but often the will eventually need to be changed or revised.
Cartiva: Unlike traditional fusion procedures, Cartiva eliminates your joint pain without sacrificing the natural movement of the foot. The minimally invasive procedure places an implant, composed of a biocompatible organic polymer, that functions similar to that of natural cartilage. The procedure allows the foot full weight-bearing capacity shortly after surgery. Cartiva can be implanted with a block of regional anesthesia. Cartiva is a technology that is innovative and can reduce pain while preserving more normal foot motion.
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