Ben Yates Consultant Podiatric Surgeon
Wiltshire
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Mr Ben Yates
Consultant Podiatric Surgeon
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Big Toe Arthritis
Arthritis of the big toe is a common problem and is termed Hallux (the big toe) Rigidus (stiffening). The big toe joint is the third commonest joint to be affected by arthritis after the knee and hip joints. Pain with stiffness develops around the big toe joint. A bony ridge starts to grow on the top of the joint and this can be painful in shoes.  As the joint becomes more painful and stiff people often adapt the way they walk which can cause problems elsewhere in the leg or foot. Sometimes only the upper part of the joint is affected and the rest of the joint is undamaged. In other people the whole joint is worn out.
 
The leaflets describe both conservative and surgical treatment options and these will be discussed in detail at your consultation.  Conservative care can include splints, insoles, footwear advice, and injections. Injections can either be steroid injections or hyaluronic acid which is the natural fluid found in healthy joints (link to injection therapy). Surgical treatment can be performed by both open and minimally invasive techniques depending upon the type of procedure performed and the level of arthritis present.
Surgery is usually performed as a day-case procedure so patients go home on the same day.
Surgery can be performed under general or local anaesthetic or with sedation.
 
What causes it?
In some people, hallux rigidus runs in the family and is a result of inheriting a foot type that
is prone to developing this condition. In other cases, it is associated with overuse – especially
among people engaged in activities or jobs that increase the stress on the big toe, such as
workers who often have to stoop or squat. Hallux rigidus can also result from an injury, such
as stubbing your toe, or it may be caused by inflammatory diseases such as rheumatoid
arthritis or gout. Your podiatric surgeon can determine the cause of your hallux rigidus and
recommend the best treatment.
 
Symptoms
Early signs and symptoms include: 
  • Pain and stiffness in the big toe during use (walking, standing, bending, etc.)
  • Pain and stiffness aggravated by cold, damp weather
  • Difficulty with certain activities (running, squatting)
  • Swelling and inflammation around the joint
  • As the disorder gets more serious, additional symptoms may develop, including:
  • Pain, even during rest
  • Difficulty wearing shoes because bone spurs (overgrowths) develop
  • Dull pain in the hip, knee, or lower back due to changes in the way you walk
  • Limping (in severe cases)
 
Diagnosis
The sooner this condition is diagnosed, the easier it is to treat. Therefore, the best time to see your podiatric surgeon is when you first notice symptoms. If you wait until bone spurs develop, your condition is likely to be more difficult to manage.
 
Conservative Treatment
In some cases, early treatment may prevent or postpone the need for surgery. Treatment for mild or moderate cases of hallux rigidus may include
Shoe modifications. Shoes with a large toe box put less pressure on your toe. Stiff or rocker-bottom soles may also be recommended.
Orthotic devices. Custom orthotic devices may improve foot function.
Medications. Oral nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, may be recommended to reduce pain and inflammation.
Injection therapy. Injections of corticosteroids or hyaluronic acid may reduce inflammation and pain (link to injection therapy).
Physiotherapy. Physiotherapy treatments may be undertaken to provide temporary relief but will rarely resolve the problem.
 
Surgical treatment
In many cases surgery is the only way to eliminate or reduce pain. There are several types of surgery for treatment of hallux rigidus. In selecting the procedure or combination of procedures for your particular case, Mr Yates will take into consideration the extent of your deformity based on the x-ray findings, your age, your activity level, and other factors. The length of the recovery period will vary, depending on the procedure or procedures performed. The leaflets explain some of the common procedures we perform.    
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