Big Toe Arthritis: Overview

Big Toe Arthritis: Overview

Big toe arthritis is a condition that affects the big toe joint. It results from breakdown of cartilage, which causes pain and stiffening of the big toe joint. Normal cartilage provides a smooth surface on the bones of the big toe, which allows the joint to move easily. When the cartilage wears down or becomes damaged, movement becomes painful and limited.

Big toe arthritis is also referred to as hallux rigidus, which means stiff big toe. Big toe arthritis occurs at the metatarsophalangeal or MTP joint of the big toe. This joint exists between the first metatarsal, or long foot bone, and proximal phalanx, or toe bone. The MTP joint of the big toe allows the toe to extend, which is needed to help the foot push off from the ground when walking.

Big toe arthritis more commonly occurs in females with an increased risk with older age. Having a family history of big toe arthritis can also increase the risk. Most cases develop over time with no known cause, although prior injury to the big toe joint can make arthritis more likely to develop. When arthritis develops after injury, it is called post-traumatic arthritis.

Other risk factors include inward-facing foot bones or an inward-facing big toe that alters the normal alignment of the big toe joint. The shape of the end of the metatarsal bone of the big toe may also increase the risk of big toe arthritis. A chevron or flat-shaped end, compared to a normal, rounded, or oval-shaped end, can increase friction within the joint and influence the development of arthritis.

The most common symptoms of big toe arthritis are pain and stiffness at the big toe joint, with increased pain when walking or going up and down stairs. The pain and stiffness may make it difficult to comfortably wear shoes. Swelling may also be present.

To diagnose big toe arthritis, a health care provider will ask a patient about their symptoms and examine the foot and big toe to assess for pain and range of motion. X-rays will also be taken to examine the space within the big toe joint. In a healthy joint without damage, there is a space between the bones of the big toe joint. This represents the thickness of healthy cartilage that is present.

In a big toe with arthritis, that space will be thinner, showing that the cartilage is damaged or worn down. If there is no space at all, that means there is no cartilage and that the bones are touching. This is commonly called bone-on-bone arthritis. Proper diagnosis from a healthcare provider will help determine the best course of treatment.