What is arthritis in the big toe? 

The great toe joint can develop arthritis, which is characterized by the wearing away of cartilage in the joint.  When cartilage is worn down, the great toe joint can become stiff and painful.  As this condition progressively worsens, the joint can become swollen and inflamed, and lead to an inability to move the joint.  This condition is called Hallux Limitus in the early stages, and progresses to Hallux Rigidus in the later stages.

What causes arthritis to develop in the big toe?

Most of the time, the bone structure that causes arthritis to develop is inherited from your parents or grandparents, just like your hair or eye color.  Sometimes, injuries to the great toe joint lead to arthritis. 

What are the symptoms of big toe joint arthritis?

Pain in the great toe joint (first metatarsophalangeal joint), especially when getting up on your tiptoes, wearing shoes with heel, or “pushing off” while running.

Stiffness in the great toe joint

Inflammation and swelling in and around the great toe joint

Palpable bony prominences (bone spurs) around the great toe joint

What are the non-surgical options for arthritis in the big toe joint?

First, it is important to address the structural component of the problem.  The great toe joint is jamming when it moves, and the bones are hitting each other, creating larger bone spurs.  This contributes to the erosion of the cartilage inside the great toe joint.  Custom orthotics with special padding to reduce the jamming in the joint is crucial to stop the degenerative process.  Second, applying ice can decrease the inflammation temporarily.  Third, injections such as Synvisc (hyaluronic acid, which is a naturally occurring substance found in joints, and is in lesser amounts when the joint has arthritis) can keep the joints lubricated and help decrease the pain.  Anti-inflammatory medication such as Aleve or Motrin help decrease inflammation temporarily but have no effect in actual treatment of the problem.

What are the surgical treatment options for arthritis in the big toe joint?

Bone spur removal around the joint helps increase the joint motion, but does not help with loss of cartilage inside the joint.  If the joint has adequate cartilage, this procedure (cheilectomy) helps increase the range of motion of the great toe joint and helps reduce the pain.

If the cartilage is worn down inside the joint, and conservative measures have failed, a joint implant is effective in increasing range of motion of the joint and relieving the pain.

If the cartilage is worn down inside the joint and the patient is an active runner/jumper/active in many sports on the feet, a joint fusion is likely the best procedure, if all attempts at conservative care have failed.  A joint fusion involves removing the joint and fusing the bones together, so there is no more motion in the great toe joint (arthrodesis).