Hallux Limitus/Toe Arthritis
Pain in the big toe joint can make walking difficult and uncomfortable. Many people aren't sure what is causing the pain and assume their pain is caused by a bunion. But is that really the cause?
A bunion is an enlargement around the joint of the big toe, which is the result of pressure being placed on the toe. When the big toe is forced inwards, the tissue around the toe joint can become swollen and painful. It is believed that bunions are partially caused by poorly-fitted shoes but we believe heredity plays a large part in that most of our patients who have bunions also have relatives with bunions.
There is another cause of foot pain that is often confused with a bunion. It is a condition called hallux limitis and it is due to a form of arthritis called osteoarthtritis.
Hallux limitus is a result of wear and tear on the joint due to improper biomechanics (improper functioning at the joint). There is also usually an enlargement of the tissue around the joint. However, unlike a bunion, where the enlargement is at the side of the joint, with hallux limitus, or osteoarthritis, the enlargement is usually on top of the joint. That may explain what is the bump on top of your foot.
If left untreated, the arthritis can worsen. Bone spurs develop around the joint, and over time, the toe becomes stiff. As the joint stiffens, the mobility of the toe decreases and the pain can increase. The bone spurs can make shoes uncomfortable due to pressure on the bone spurs, and it is often difficult for women to wear high heels because the big toe won't bend enough at the joint.
There may be a family tendency to develop arthritis at the big toe joint (also called the first metatarsal phalangeal joint). Those with structural abnormalities in their foot, such as a long or elevated first metatarsal, also run the risk of developing hallux limitus due to abnormal jamming at the joint.
Non surgical treatment for arthritis may include made to measure orthotics, which can improve the functioning of the joint by allowing the elevated first metatarsal to drop (plantarflex) a little in order to relieve the jamming at the joint. Low heeled, stiff soled shoes with a roomy toe box can also help. Steroid injections can reduce the swelling, but multiple injections cause cause thinning of the connective tissues. Laser treatments, and ice can also relieve the pain and swelling. at the soft tissues.
If conservative methods, such as described above, do not give satisfactory relief, you may be a candidate for minimally invasive surgery.
Using local anesthetic, I remove the bone spurs, which cause the bump, and I will often shorten the first metatarsal in order to reduce the jamming that caused the wear and tear at the joint. This is accomplished through very small openings in the skin, thanks to specialized instruments developed by podiatrists.
Smaller openings result in less trauma to the soft tissues. This usually means considerably less pain and swelling compared to traditional orthopedic joint destructive procedures such as fusing the joint or removing part of the joint. I prefer to preserve the joint whenever possible.
You can begin limited walking immediately, casts are not necessary, and most people do not need medication stronger than Aspirin, Tylenol or Ibuprofen.
After surgery I apply an adhesive tape dressing. I will change it for you weekly for five weeks. On the sixth week, you can take it off yourself, at home. Then I will see you every three months for a year to make sure you are doing well.
If you have hallux limitus, or a bunion, please call my office at (416) 486-9917 for a private consultation. I will explain the nature of your foot problem and tell you your options.