Big toe osteoarthritis

What is big toe osteoarthritis?

Osteoarthritis of the big toe or hallux osteoarthritis refers to a loss of cartilage substance on the joint surfaces.

Osteoarthritis of the big toe can affect the metatarsal head and the phalanx, which is known as metatarsophalangeal osteoarthritis. If the sesamoid bones are also affected, it is called associated metatarso-sesamoid osteoarthritis.

The symptoms of big toe osteoarthritis

The main symptoms are pain, joint swelling, and then stiffness.

• The pain is mainly mechanical, that is to say, brought on by activity. Big toe pain decreases with rest. During osteoarthritis flare-ups, the pain can persist even at rest, for several weeks.
• The joint is generally more inflamed, with an increased secretion of joint fluid, which can be responsible for episodes of visible joint swelling.
  The production of articular bone spurs called osteophytes can be responsible for mainly dorsal joint deformities.
• Any osteoarthritis tends to be stiffening; this is a natural joint protection mechanism. Tissue stiffness helps limit joint movement, reduce rubbing of damaged joint surfaces and thus pain.

Big toe osteoarthritis or gout?

Big toe osteoarthritis is a mechanical problem, while a gout attack is an inflammatory problem.

• Gout corresponds to a release of microcrystals of uric acid into the joint. Gout and articular chondrocalcinosis are types of microcrystalline arthritis.
  The release of uric acid crystals happens in the joint, but also in peripheral tissues, particularly at the capsular and ligament level of the hallux. The clusters of uric acid form a kind of chalky mud, which is the gouty tophus.
• Gout of the big toe mainly affects men aged 50, who are generally hearty eaters and drinkers.
  The big toe then becomes red, swollen with loss of visible skin folds, very painful when moved, and also sensitive to light touch of the skin.
• Successive gout attacks will cause deterioration of articular cartilage, leading to metatarsophalangeal arthritis and a tissue buildup of uric acid crystals.
• The diagnosis of gout is clinical; blood tests may show a high level of uric acid.
  X-rays may reveal joint damage and deposits of crystals in the peripheral tissues.

What are the causes of big toe osteoarthritis?

There are several causes of hallux osteoarthritis: trauma, joint instabilities, and the relative length of the big toe known as hallomegaly.

• Trauma such as articular fractures of the 1st metatarsal or the 1st phalanx can lead to metatarsophalangeal osteoarthritis.
  Any articular fracture causes cartilage damage, which will be responsible for osteoarthritis in the medium or long term. However, osteoarthritis can remain asymptomatic.
  There is no radioclinical correlation. Sometimes we see foot X-rays with very damaged joints in patients who have no pain. Conversely, some patients experience a lot of pain even though X-rays show what appear to be minor lesions.
• Joint instabilities cause abnormal shear forces in the joint that lead to cartilage damage and osteoarthritic deterioration.
  Hallux valgus is a form of joint instability. After long-standing evolution of this deformity, we may observe osteoarthritic lesions, usually with stiffening of the metatarsophalangeal joint. This is known as arthritic hallux valgus, or otherwise called hallux rigidus valgus.
  Severe sprains of the hallux can also cause osteoarthritis. Turf toe refers to ligament, capsular, and tendon injuries of the metatarsophalangeal joint of the hallux. Depending on the initial severity of the injuries, surgical treatment may be considered to stabilize the joint.
• A long big toe may be more easily traumatized, especially in shoes. This is what is known as hallomegaly, where repeated microtrauma can cause osteoarthritic lesions.

What are the treatments for big toe osteoarthritis?

Big toe osteoarthritis can benefit from natural treatment. Traditional painkillers and anti-inflammatories can be used symptomatically to manage pain.

Silicon, collagen, and amino acids may be protective factors for the joints, especially cartilage. Several laboratories offer formulas combining these different molecules, generally in 15-day courses, to protect joint cartilage.

Exercises

Self-rehabilitation exercises, done by oneself, can be beneficial for pain from big toe osteoarthritis. It is necessary to maintain mobility of the hallux, without trying to increase it, as forcing the joint promotes painful flare-ups.

Very often, there is a contraction of the calf muscles, the gastrocnemius, which will need to be stretched.

Orthopedic insoles

Wearing shoes with stiff soles helps limit joint movement. Orthopedic insoles with reinforcement under the hallux metatarsophalangeal joint can be suggested for wearing more flexible shoes.

Metatarsophalangeal osteoarthritis surgery: surgical operations

There are several types of surgical procedures. When the joint can be preserved, with hallux enlargement and a long first metatarsal, a decompression procedure by osteotomy may be considered.

If the joint is too damaged to be preserved, replacement with a spherical pyrocarbon prosthesis is a good option to maintain mobility. The alternative to a prosthesis is arthrodesis of the hallux rigidus, which consists of permanently fusing the metatarsophalangeal joint. This is mainly done in cases of:

• Severe associated deformity
• Joint instability
• Insufficient bone stock
• Little or no residual mobility