A common condition that affects the big toe joint known as 1st metatarsal phalangeal joint. This can be reduction of the cartilage in the joint space, so the big toe does not move freely and is limited in its movement. This can lead to pain, stiffness, and an enlarged joint.
Osteoarthritis can result from a combination of genetic, environmental and lifestyle factors. It can affect anyone at any age but is more common over the age of 45. Being over-weight can put stress on the joints and a previous injury can increase the risk of developing osteoarthritis.
The big toe can be painful on when you bend and flex it, there may be inflammation of the soft tissue around the joint, and the joint may increase in size. Often, footwear can be more challenging as compression can aggravate symptoms along with over-movement of a stiff joint.
Osteoarthritis (OA) of the foot and ankle | Versus Arthritis
Managing weight is important, therefore a balanced, healthy diet is encouraged. If you are over-weight, reduction of this will be beneficial to your feet to reduce joint over-load whilst a balanced diet is important for your overall health.
Smoking does not help bone and soft tissue repair, so cessation is advised.
See our “Healthy Living” section for more information on local stop smoking and healthy weight services
A cushioned thick sole with a curved front rocker can help forefoot symptoms. This allows recovery and forefoot propulsion, but this needs to be cushioned and stable- avoiding overly flexible shoes. A removable insole is ideal if you need to use foot orthotics. Appropriate width at the toe box avoiding tight shoes or stiff side materials over the big toe joint.
An insole or foot orthotic can help reduce pressure with cushioning materials or firmer materials that offer structural support. It is not one-size-fits-all, sometimes a cushioned insole is suitable, with small metatarsal pad. However, some feet do benefit from a more substantial arch support. An arch support can help support the contour of the foot which in turn can reduce pressure to the ball of the foot.
Activity is encouraged, although adaptation is important. At times, high-impact activities might need to be scaled back. Instead, introduce activities that allow your symptoms to recover but keep you active. Monitoring step count or intensity of walking are ways to modify your activity.
Toe exercises can help if there is partial limitation in the big toe joint movement, but for some exercises might make the joint feel more uncomfortable. Some light mobilisations of the joint can help some symptoms.
Big Toe Therapy Band Exercise – Insoles and Orthotics – Healthy Step
If you prefer to stretch your calf muscles whilst seated you can use a towel or a belt to stretch your calf muscle.
A steroid injection can be given into the joint space which can help reduce swelling and reduce pain. There are risks that the steroid can affect the surrounding tissues and sometimes adverse reactions can increase symptoms.
Toe surgery is only recommended as a last resort, non-operative treatment measures have been exhausted and if your symptoms remain significant. In most cases the operation is performed under a local anaesthetic. The choices are surgery to clean up the joint or fixation of the joint. The consultant surgeon will help guide you on the most appropriate surgery for you condition.
This involves removal of the bone spurs at the joint- this can result in greater movement in some cases although can still lead to a joint fixation at a later date.
This involves the joint being stabilised with screws, staples or a metal plate. Joint replacement surgery will involve removal of bone for an implanted material at the joint surface. Your surgeon will advise you on the appropriate method to suit you.
There are risks to foot and ankle surgery
Off-work There will be a requirement to elevate your foot and rest non weight bearing then semi weight bearing.
Swelling and Stiffness- The foot can swell as a response to surgery and as part of the healing process. It can take up to six months for swelling to completely settle in some cases. Although in some cases post-surgery there may be increased stiffness in the foot.
Infection- The act of surgery is invasive which is also a risk to infection. In some cases, this can delay healing and will require antibiotic treatment.
Bloods Clots- A small risk of developing a blood clot after foot surgery. Following the pre and post operative advice will help reduce this risk.
Persistent Pain/ Numbness Some patients have persistent pain post-surgery or complications that may involve altered sensations in or around the surgical site
Chronic Regional Pain Syndrome Surgery can sometimes result in a swollen, painful and highly sensitive foot. This can be challenging to manage and often patients will be referred to the pain clinic for support.
Criteria Based Access
In Bristol, North Somerset and South Gloucestershire neuroma surgery falls under the criteria-based access (CBA) Forefoot surgery policy. Therefore, you must have exhausted and evidenced the conservative treatment options available. A consultation with a foot and ankle specialist can help discuss the treatment you have been doing and what further options are recommended. Funding for surgery will be considered if the problem is causing pain or severe functional impairment and treatment has been exhausted.
Contact your general practice if you need further help and guidance, a referral to local musculoskeletal services is required in some instances, and they can advise on appropriate treatment or pathways suitable to you.
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