There are a number of reasons that you may experience painful big toes. The three most common are all related to abnormal function of the big toe joint. Those are:
What is Hallux Rigidus?
Hallux rigidus means "stiff big toe joint". This condition is a type of
"wear and tear" arthritis in which the joint surfaces at one of the
joints in your big toe begin to both wear away and develop extra bone,
called osteophytes or ‘spurs’, that further limit motion. This joint is
very important because it has to bend significantly with every step you
take.
Hallux rigidus only gets worse over time. The earlier it is treated the
easier it is to eliminate your pain and help you avoid surgery. Often
correctly prescribed foot orthotics
will eliminate pain and help reduce further damage.
Symptoms of this Hallux Rigidus include pain in the toe when you are
active (especially as you push off with your toe), swelling, a loss of
motion in the joint and bone spurs on the top of the joint. Walking may
become painful. As you change the way that you walk because of pain, you
can develop pain in your knees, hips and lower back.
Diagnosis of hallux rigidus is usually done by physical examination and
x-ray. X-rays will show the location and size of any bone spurs that
have formed, as well as the degree of damage to the joint itself.
Figure 1: Decrease joint space/arthritis great toe joints
How did I get Big Toe Joint Arthritis?
Your big toe undergoes a tremendous amount of stress when you are
walking. Forces that equal twice your body weight (more when running)
pass through your foot on every step. Your big toe, along with the
‘ball’ of your foot, was designed to bear much of that force.
If you have a foot where the arch of your foot collapses too much, as in
the case of flat feet (also known as over-pronation) your big toe is
unable to bend normally. This causes the joint of your big toe to jam
along the top of the joint and even partially dislocate with every step.
Over time, this leads to arthritic changes, cartilage damage and the
formation of spurs.
In addition, hallux rigidus can be caused by or made worse by trauma,
carrying too much weight and anatomical deformities of the foot.
How is Hallux
Rigidus treated?
Foot Orthotics: The correct custom made orthotic will reduce or
eliminate your pain by restoring more normal motion to the big toe
joint, preventing jamming of that joint and effectively releasing the
big toe, allowing it to move and function properly. A very specific
orthotic prescription, based on the best evidence in the medical
literature, allows us to treat the cause of your pain rather than just
the symptoms. With the correctly prescribed orthotic, harmful joint
stresses can be reversed, allowing affected tissues to heal and joint
function to be improved. In this way the orthotic provides both primary
treatment and preventative care by working to restore normal function
and range of motion to your big toe.
In order to best improve function of your big toe joints, research has
shown that orthotics must be made from
non-weightbearing casts of your
feet with the foot held in the position that provides the best
function of the big toe joint. In addition, the orthotic itself must
conform very close to the arch of the foot.
Figure 2: As seen here, orthotics for hallux rigidus should conform closely to the arch of the foot.
Proper orthotics can be the most effective way to treat big toe pain and
prevent surgery. Because hallux rigidus gets worse over time you should
not wait to be evaluated. For a complete
evaluation of whether orthotics can help your big toe problem, make an
appointment today to see us in our Seattle office.
Anti-Inflammatory Treatment: This may include ice and
anti-inflammatory medications. These may provide some temporary relief
and ease the pain of inflammation, but are not helpful in addressing the
underlying cause of your condition.
Footwear: We will provide you with recommendations for specific
shoes that will act to reduce pressure on the big toe. A stiff-soled
shoe with a rocker or roller bottom may be recommended to help you walk
and lessen the bend in the big toe. A shoe with a wide toe box may also
help relieve pain. We can even help you find
high heel shoes that work best for
patients with big toe pain. Weight loss
can also be important in reducing hallux rigidus pain.
Surgery: In cases that do not respond to conservative measures,
we may recommend surgery. At the Foot and Ankle Center of Washington
surgery is always a last resort, but there are times where it is
necessary for pain relief. There are a few common surgeries that are
performed depending on the degree of arthritic changes. Removal of the
bone spurs, joint fusion, and complete joint replacement can be
performed. These procedures are not without risks and often the disease
continues to progress after a temporary period of pain relief. Also,
operative measures performed on one foot may cause problems on the other
foot due to the extra load. We will provide you with complete and
detailed information so that you can make an informed decision.
Don’t let your big toe pain get worse. Early treatment can prevent future problems. Call today for an appointment in our Seattle office.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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