Surgery to Treat Arthritis of the Big Toe Joint

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Arthritis of the big toe joint is common, and can be particularly disabling. Japanese Toe Nail Fungus Code Review  Options to manage this condition non-surgically are few, given the express need for the big toe joint to attempt bending during the walking cycle. This article discusses the cause of this painful arthritis, as well as surgical treatment options to relieve pain.

The big toe joint consists of the first metatarsal bone forming the 'ball' of the joint, and the initial bone of the big toe (the first proximal phalanx) forming the 'socket'. It has an important role in how the body moves when walking, and limitation of its motion forces other joints and muscles to function abnormally to take up the slack. Arthritis of this joint, or cartilage wear, occurs when there is abnormal pressure or positioning of the joint bones. This results in grinding down of the smooth cartilage that covers the bone surface at the joint, allowing for smooth motion. As this cartilage erodes, the bone underneath begins to become exposed, and parts of the joint surface start to see bone rubbing during joint motion.

In addition to this, thickened spurs of bone can develop along the margins of the joint, further hampering motion. When bone grinds on bone and when spurs limit joint motion, pain usually results. This condition will gradually worsen, leading to destruction of much of the joint surface. In severe cases, the bones will even partially fuse together. The structural cause of arthritis can be due to many factors. Natural bone structure can contribute to this, such as seen in people with longer or shorter first metatarsals, as well as first metatarsals that are angled too steeply in elevation or declination with respect to the ground surface. Bunions and other rotational deformities of the big toe joint can also contribute to cartilage wear and tear. Fractures, crushes, sprains, and other injuries to the joint can also result in arthritis after awhile. Finally, certain body-wide joint-affecting diseases will cause joint erosion as well, such as seen with rheumatoid arthritis and psoriasis.

Non-surgical treatment is limited, consisting of measures to limit the painful motion of the joint and decrease the resulting inflammation. Stiff soled shoes and specialized custom foot inserts can be used to limit the painful motion. Anti-inflammatory medications and steroid injections can reduce the inflammation, although this is not nearly as effective as it is in larger joints like the knee. However, the unique structure of the big toe joint generally necessitates surgical treatment in many cases of arthritis. Surgical treatment is divided into procedures that destroy the joint and procedures that maintain the joint (in the case of mild arthritis). When joint destruction is severe or significant, the joint destruction technique is chosen as the cartilage of the joint will have to be replaced or removed entirely in order for the pain to be resolved.

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