Ask Dr. Anderson: What Causes Big Toe Arthritis?
Dr. Anderson discusses conditions linked to big toe arthritis and explains treatment options.
If you experience pain at the base of your big toe when you walk, you aren’t alone. In fact, as many as 40 percent of adults over the age of 50 are affected by painful toes. The cause? Big toe arthritis, which is the most common cause of foot pain. Foot and ankle surgeon Dr. Michael Anderson publishes articles about big toe arthritis. He explains how this arthritic foot condition develops.
People affected by big toe arthritis
“Big toe arthritis affects a lot of people,” acknowledges Dr. Anderson. “Our big toe is a joint, and arthritis can affect the toe joint just as it can affect any other joint in the body. One of the most common symptoms is a feeling of pain at the base of your big toe when you walk.”
How toe arthritis develops
“Arthritis in the big toe progresses just like any other arthritic joint condition,” he continues. “The joint at the base of our big toe is called the metatarsophalangeal, or MTP, joint. The ends of the bones in the joint are covered by smooth articular cartilage. You bend this joint every time you take a step.
Painful conditions caused by toe arthritis
Over time, as wear and tear or injury damage the articular cartilage, the bone ends become raw and rub together. As the joint degenerates, it begins to stiffen. Walking can become painful and difficult. The gradual loss of protective cartilage can prompt the development of several painful conditions.
- Without the cushion of cartilage, joint bones become raw, and may begin to rub together painfully.
- “You may experience the growth of a bone spur on the top of the toe bone,” says Dr. Anderson. “This bone spur, or overgrowth, restricts the toe from full range of motion as you walk.”
- Rubbing bone and protective bone growth can irritate the tissues around the joint, causing inflammation.
- You may experience joint space loss in this formerly limber joint as bone friction inflames the joint and bone spur growth crowds in to restrict joint motion.
“In some patients,” notes Dr. Anderson, “bone spurs develop that prevent their toe from bending appropriately—but they don’t have much midrange pain. This is good. It tells us that, over all, the arthritis is fine. These patients can move their toe around and it doesn’t hurt. The telltale symptom of big toe arthritis reveals itself when these patients try to bend the toe up. Because that is going to hurt a lot.
Conservative treatments for toe arthritis
Treatment for big toe arthritis varies with the severity of the symptoms. Options range from conservative treatment to bone spur removal and joint fusion. “Patients who can walk comfortably even though they may feel the occasional twinge can choose to manage the pain without surgery,” says Dr. Anderson. “If the pain is too intense, we can consider surgical treatments to remove bone spurs and some of the inflamed tissue.”
Surgical options for toe arthritis
For patients who are still in pain, the next step is surgical fusion of the joint. “We fuse the two bones in the toe joint, using plates and screws to hold the bones together,” Dr. Anderson explains. “Although some surgeons have attempted to replace the big toe joint, replacement is not an advisable option. Walking concentrates all the force of the body in the big toe. So, when you do a big toe replacement, implants are subject to crazy stress loads. Historically, they have failed. Then bone loss can develop, and that’s not an experience patients want to face.”
An emerging new implant treatment for toe arthritis
“There’s also a new product, called Cartiva®, that provides another valuable option for treating big toe arthritis,” Dr. Anderson points out. “Cartiva is a synthetic cartilage used to replace damaged cartilage in the toe joint. It’s an exciting implant. I have extensive experience with Cartiva procedures through my fellowship mentor, Dr. Judith Baumhauer. She was instrumental in the studies leading to its FDA approval. It’s not the right solution for everyone, but it is one more option for patients to consider.
“The fact that arthritis isn’t curable doesn’t mean patients have to accept pain,” says Dr. Anderson. “We have many treatment options that make a huge positive impact on quality of life. At Summit, we are here to explore how various options might achieve your personal objectives. Helping patients determine which medical approach is right for them is a big part of what I do.”
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