Big Toe Arthritis: Treatment Options

Big Toe Arthritis: Treatment Options

Big toe arthritis tends to get worse over time if left untreated. Fortunately, nonoperative treatment is preferred for most people. Typically, 55 to 75% of patients with big toe arthritis will not require surgery.

Nonoperative treatment for big toe arthritis includes wearing supportive footwear, using orthotics inside of shoes to provide support under the big toe, avoiding activities like running and jumping that stress the big toe joint, anti-inflammatory medications, and injections into the big toe joint for pain relief.

If a patient continues to have pain after trying nonoperative treatment, surgery may be considered. There are many different types of surgical procedures that can be performed. This depends on the extent of the big toe arthritis as well as the patient's age and activity level.

Surgery may be performed arthroscopically through small incisions or through an open incision along the top of the big toe. Sometimes, bone needs to be removed to decrease pain. A surgeon may choose to perform a cheilectomy to remove painful bone spurs from the top of the metatarsal bone and some of the big toe joint surface.

A Moberg osteotomy is another option, where a surgeon will cut and remove a wedge of bone to improve the alignment of the big toe joint. This shifts the distribution of pressure and helps increase the range of motion of the big toe.

Interpositional arthroplasty can also be used to treat big toe arthritis to reduce irritation and help preserve motion in the big toe joint. This procedure shaves down the end of the metatarsal bone and replaces it with a soft tissue graft.

In the past, a total or partial joint replacement was performed where the surfaces of the big toe joint would be shaved down and replaced with metal caps, but these procedures are typically no longer recommended due to poor treatment outcomes.

In more severe cases of big toe arthritis, joint fusion may be needed. With big toe joint fusion, the cartilage is completely removed from both surfaces of the big toe joint, and the bones are fixed together with a metal plate and screws. This stabilizes the joint to reduce pain but also restricts movement of the big toe.

After any type of surgery, weight-bearing is typically limited to allow the big toe joint to heal. This may involve staying completely off of the affected foot for a period of time or using a walking boot to reduce pressure from the big toe joint. After a few months, the patient should be able to walk normally without using any assistive device.