One of the most common places for arthritis to occur in the foot is the big toe join. The condition can present in several different ways. A bunion deformity, which is a dislocation of the great toe joint resulting in a large bump in the inside of the foot, can lead to arthritic changes in the joint causing pain and grinding. Osteoarthritis of the great toe joint is the result of chronic grinding and eroding of the cartilage surfaces leading to “bone-on-bone” and eventually a large bump on the top of the toe joint.
When the deformity becomes painful there are several pathways that we follow to treat this. One is reducing the inflammation by either taking anti-inflammatories such as ibuprofen or naproxen, or cortisone injections into the joint. This can last anywhere from a few weeks to several years depending on the severity of the deformity.
Orthotics can be implemented to reduce motion but rarely are they effective at reducing pain.
Surgery is the most advantageous option in treating this condition and the procedure is dependent on the severity of the arthritis. For mild cases, simply “cleaning out” the joint by removing fragments and remodeling the head of the metatarsal can provide relief. This will also stop the progression of the condition and prevent further joint damage which could cause more pain and irreversible damage.
Moderate cases can sometimes be treated by inserting an implant into the joint which can preserve the motion as well as reduce pain. The implants have a good prognosis but do sometimes come with pain and swelling. Choosing the appropriate deformity for inserting the implant will offer the best outcome.
More severe cases will need to be fixed by fusing the great toe joint. Fusing the joint will prevent motion but had the best prognosis for stopping the pain.
Each option has its own recovery period ranging from 2 weeks to 6-8 weeks.
Evaluation and X-rays can be done the same day to provide the patient how severe their arthritis is.