Arthritis is a degenerative condition of cartilage (smooth liner of joints). Arthritis of the big toe is among the most prevalent foot arthritic problem that affects 1 out of 40 individuals over 50 years old. Females are more frequently affected and the condition usually is diagnosed between 30 to 60 years.
The condition is often life-altering, limiting the ability of a person to do things that used to be enjoyable for them, causing pain and limiting the shoe options.
Symptoms and Clinical Presentation
The majority of patients experience discomfort at the joint of their big toe particularly when they push away to go for a walk. Patients report swelling and stiffness on the large toe and a big bump in the top portion of the toe, which can hinder the use of shoes.
Diagnosis
The majority of cases are diagnosed by examining the patient's background and physical examination by itself. X-rays can help determine the severity of the arthritis as well as the extent and location of bone spurs.
Treatment Options
Treatment that is not surgical
The first line of treatment. It consists of anti-inflammatory medicines as well as ice and modifications the type of shoes you wear to stay away from narrow, flexible shoes.
Shoes with inserts (Morton's extension) are a great way to reduce the motion of the toe's big joint, and help relieve the pain. Sometimes, steroid injections may provide some relief from symptoms but are not able to reverse the arthritis process.
Treatment for Surgical purposes
If non-surgical options for treatment have not worked, there's surgical options to treat of arthritis of the big toe.
Cheilectomy (bone spur removal)
A Cheilectomy or removal of bone spurs involves cutting the bone spur from the sides and tops of the joint. This procedure is usually reserved for minor arthritis.
Cheilectomy can provide reliable improvement in the difficulty of wearing shoes as well as good pain relief and a slight improvement in mobility. Patients can enjoy a rapid recovery and allows them to weigh bear (stand up and place the weight onto your foot) to be able to walk around immediately after the procedure.
The biggest drawback to this procedure is that, should the arthritis worsen the patient could need an additional operation in the future.
Arthrodesis (fusion)
Advanced arthritis has been traditionally treated with surgery to fuse the large toe. This procedure involves removing the cartilage that has been damaged is removed, and then the two joints are joined using screws and plates to enable them to heal. The procedure is able to eliminate all remaining motion in the big toe joint.
Fusion is highly reliable in alleviating pain permanently from joints. Studies have demonstrated a positive improvement in gait, with little functional limitations. It is also an ideal option for patients suffering from arthritis that is caused by deformity of the toe.
The main drawback of this type of surgery is that the result will result in a totally rigid joint. This will adversely affect patients who wish to run, or take part in sports that require movement that involve the toe's big (such as yoga poses). The healing process is more extensive than that of removing the bone spur and requires an ankle weight bearing for six weeks following the surgeryand 3 months after surgery until the patient can walk with normal shoes. There is also some chance that bones will not grow together (called an ununion) that requires a different operation to treat.
Replacement for the toe
Total toe replacement (both sideways) and the hemiarthroplasty (half of joint) are being studied for the treatment of arthritis in the big toe. A successful toe replacement could reduce pain, improve motion and enhance functionality. Additionally, it will be long-lasting and be able to be redesigned in the event of failure.
However, there isn't enough evidence from orthopedic studies to justify the use of implants to replace the toe's big. A lot of implants are impacted by the early loosening of implants, stiffness, or failure that requires complex revision operations.
Implants of synthetic cartilage
Recently it was announced that the FDA has approved an implant to be used for use in the United States that has been employed by both the United Kingdom and Canada since 2009. In July of 2016 the first implant made of synthetic cartilage was implanted by a surgeon in the United States. In this procedure, injured cartilage will be removed, and then replaced by biocompatible, biomedical-grade polymer implant. It provides the appearance of cartilage, is flexible, low-friction, and durable bearing surface.
In contrast to the fusion procedure the patients are able to begin to lift weights immediately following the procedure if they are able to do so. Two significant papers with five and two-year results were published recently in the renowned medical journal for foot and ankle surgeries.
The preliminary results indicate an excellent relief from pain, with preserved motion, positive functional results, and rapid recovery that allows quick weight bearing. If patients continue to suffer from pain, patients are switched to a standard fusion process (in contrast to surgery to replace the toe).
Visit foot Focus Podiatry for a complete treatment of big toe joint Arthritis Perth
Are you looking for a doctor to help you deal with foot issues?
Do you struggle to find the best doctor for podiatry Essendon?
Your foot is a complex area of your body, and you should hire the most experienced doctor to help you consider the right option.
