Today I’m talking about arthritis of the big toe joint. This is also called hallux rigidus. So essentially what this is, it’s arthritis of this joint here. So if you look at a normal step what should happen as we walk is this joint bends 60 to 80 degrees. You can imagine, if this joint wears out, which is what arthritis is, how painful that can be. So as you walk forward now, you can no longer bend this joint. Now let’s look over at this picture here. So this is what that joint should look like with that cartilage in that joint a hundred times smoother than glass. As it starts to wear out, this cartilage gets thinner and thinner to the point where down here we have hallux rigidus or that there is no cartilage left and essentially there is no motion left in this joint, or if there is motion it’s just a few degrees that leads to pain.
So when we look at trying to treat this problem initially, our goal is to eliminate the pain so that people can walk pain free and do the activities they want to do. In most cases if it is early on, meaning there is not bad arthritis, we want to do something to enhance the motion in that joint. In that situation we might use either a prefabricated or a customer orthotic to try and bring this bone down a little bit more because whenwe do that, that helps the motion in this joint. But over time if this joint gets bad enough that it really starts to get quite worn out and there’s very little cartilage left, that isn’t going to eliminate pain. In order to eliminate pain we have to do something to stop motion and there’s several ways to do that. First of all, we still want to use either a prefabricated or custom orthotic to transfer pressure off of this area and get more pressure back here.
Custom orthotics tend to work better because they conform closer to the arch but there’s also some good over-the-counter devices that can work. Actually if you go to our website and do a search for hallux rigidus or big toe arthritis, you’ll find a list of over-the-counter devices that might help you. The second thing that we might do is do some shoe changes. You can buy shoes, either athletic shoes or dress shoes or walking shoes that are rigid on the front. This is called a rocker sole. You can see I cannot really bend that sole. So as this person starts to walk forward in this type of shoe, the shoe rocks you through the step and the toe joint does not have to move. That can be very effective at eliminating motion in that joint and eliminating pain. You could also purchase what’s called a turf toe plate. It’s a rigid plate that goes inside a shoe in order to stop motion. There’s even women’s dress shoes on the market that come with platforms, for example.
Those have rigid soles on them. So we’d like to do all of this before considering surgery. There are surgical options that can also be done. If it gets too bad where you got real arthritis in that joint, usually you’re considering a fusion of that joint. Usually it’s actually a fairly effective surgery, most patients do very well, but we always consider surgery a very last resort. So if you have pain in your big toe joint, don’t live with it. It can only get worse. Often we catch it early enough, we can prevent further damage or at least slow the potential for damage. Later on if there is quite a bit of damage of the joint, we can still do a lot to eliminate your pain. So if you’re in our area, make an appointment to see us. If you’re not in our area find a podiatrist that specializes in biomechanics and orthotic therapy. They can usually help you a lot..
As found on Youtube