December 7, 2012

Big Toe Joint Pain

The first metatarsophalangeal (1st MTP) joint, or the ball of your foot, is a common place for pain and deformity to occur. Careful assessment is required to isolate the true nature of these complaints.

Hallux Rigidus

When osteoarthritis occurs in the 1st MTP joint, it is known as hallux limitus or hallux rigidus, depending on the severity of the disease affecting the joint. This joint is one of the most commonly affected joints in the body to develop osteoarthritis, usually secondary to mechanical overuse, previous trauma, or a genetic predisposition towards osteoarthritis.

Treatment is usually directed as trying to preserve the cartilage located within the joint, in order to reduce discomfort and delay or prevent the need for surgery. Often foot orthoses and footwear modifications are used to manage hallux rigidus or hallux limitus, along with medications and activity modification. Severe arthritis and pain in the joint may often be an indication for surgery, which may involve reducing the spurs and excessive bone growth around the joint, or stiffening the joint permanently using pins or screws.

Hallux Valgus (Bunion)

halluxvalgusbuniontoe

A very common deformity affecting the great or big toe joint is hallux valgus, also known as a bunion joint or bunions.

Hallux valgus can be due to genetic predisposition, mechanical factors and is often aggrevated by poorly designed or fitting footwear. The appearance of a bump on the side of the big toe joint is due to a slow subluxation of the 1st MTP joint and gradual misalignment of the big toe with the 1st metatarsal bone.

Over time, this has a tendency to cause uneven wear and tear of the cartilage within the joint, and eventually lead towards osteoarthritis. However some people can be lucky enough to get considerable deformity of this joint without pain or symptoms – though fitting the foot within regular footwear will become increasingly difficult.

Clinical and X-ray examples of a patient with hallux valgus (bunion)

Treatment

Specialised footwear modifcations including shoe orthoses (or orthotics) , splints, toe spacers and footwear modifications allow patients to live with the problem in inproved comfort, though surgery is usually the only way to correct the joint back into its appropriate position and alignment.

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