Bunion or Arthritis? What is that bump on top of my big toe joint?
posted: Sep. 19, 2013.
When is a bunion not a bunion?
Answer: when the deformity is actually an arthritic joint, a condition also called hallux limitus.
It is easy to confuse one for the other. They both affect the first metatarsal phalangeal joint or big toe joint.
When you have a bunion, there is usually a bump or bony enlargement at the side of the first metatarsal phalangeal joint. This is due to a sideways deviation of the first metatarsal away from the second metatarsal. The big toe moves to the opposite side, and presses against the second toe. There is usually good mobility at the joint in that the big toe is able to move up and down fairly easily. However, if the bunion is left untreated, the joint will become stiff over time.
With hallux limitus, the first metatarsal is often dorsiflexed, or slightly elevated. It does not deviate sideways. When the first metatarsal is elevated, the big toe often plantar flexes or moves downward, not sideways toward the second toe. There is often limited mobility at the joint. With normal walking, the big toe has to elevate. Due to stiffness in the joint, the big toe jams against the metatarsal. This causes wear and tear at the joint. This causes bone spurs to form on the top or dorsal aspect of the joint, and gradually the cartilage wears down. This type of degeneration is called osteoarthritis. When you have stiffness at the big toe joint due to osteoarthritis, we call this hallux limitus.
Hallux limitus can be treated non-surgically with made-to-measure orthotics which improves the mechanics at the foot and can relieve some of the jamming at the joint.
The arthritic changes with hallux limitus can also be treated surgically, in many cases, with minimally invasive surgery, also called minimal incision surgery.
Working through small opening in the skin, the foot surgeon remodels the bone spurs on top of the joint so that when the foot heals, the shoe does not press on the joint.
If necessary, a cut is made in the first metatarsal bone to lower the first metatarsal head into a more functional position and to shorten the metatarsal. Although the damaged cartilage cannot be replaced, this procedure is often enough to reduce the stress at the joint, thus reducing the forces in the joint and enabling the foot to function more normally with considerably less pain. In many cases, this is much more preferable than the conventional hospital procedure which involves fusing the joint.
I have been performing minimally invasive surgery to treat arthritic joints in my Toronto foot clinic, with local anesthetic, for many years.
If you are not sure whether you have a bunion or hallux limitus, or simply want to get rid of the pain, please call my Toronto podiatry office at 416-486-9917 to arrange a private consultation.
I am here to help.