Big toe pain

There are many causes of pain felt within the big toe. Sporting injuries can cause injuries to the soft tissues and joint srfaces. Gout is an inflammatory condition with can affect any joint but favours the big toe. The commonest cause is due to arthritis.

 

Arthritis of big toe

The medical term for this condition is ‘hallux rigidus’, which means 'stiff big toe'. There may be painful hard lumps around the toe which may rub on shoe-wear.

 

Background

 In the majority of patients, the cause for arthritis of this joint is not known and rarely stems from an injury. It can often start early in adulthood but mild cases do not necessarily progress to full-blown arthritis. Arthritis of the big toe does not usually mean that you will develop arthritis in other joints (such as your hip or knee). Once you have early arthritis wear wide, comfortable shoes with a stiff sole. Do not become overweight (this increases force through the joint enormously and will wear it out more quickly).

 

Treatment options

 In early stages, simple pain killers are effective as is losing weight. For some patients a steroid injection may help. If surgery is required there are a number of options:

1. Removing the bony lumps. Useful in early arthritis.
2. The most reliable operation is a fusion. The joint is removed and the bones are held together with screws while the bones join together. This converts a stiff painful joint into a stiff non-painful joint.
3. Removal of the joint and interposition with a tendon. This operation allows a little movement of the joint but leaves the big toe weaker.
4. An artificial joint (either partial or complete). This operation preserves most of the strength and movement of the toe. There is a risk of infection and of the artificial joint becoming loose. The long-term effects of this operation are not known. Not a good option for young, active patients.

 

Benefits of surgery

 The main aim of any operation is to relive pain and allow improve walking. The correct operation for you will have been discussed with you during your consultation.

 

Risks of surgery

 Each operation has its particular benefits and risks. Wound infections, blood clots in the calf and persistent pain in the toe are common to all operations (although rare). The risk of the bones not joining up together (a non-union) following a fusion is also small. All of these risks are significantly increased if you smoke.

 

Recovery

 Whatever you operation, you will have a bandage (no plaster of Paris) and a special sandal fitted to allow you to walk. Crutches may be required for a week or so. Six weeks after surgery you will have an X-ray to ensure the bones are healing and at that point you will be allowed to wear more normal footwear. You may still have some swelling at this stage which settles down 3-4 months after surgery. Time off work depends on your job but 6 weeks is a guide.

 

Example of big toe fusion     Example of partial joint replacement