Osteoarthritis / Hallux Riaidus
by Evan A. Vieira, DPM, AACFAS
Osteoarthritis or just, arthritis for short, is a degenerative condition that affects joints. Our joints are supported in part by the firm rubbery buffer known as cartilage, which provides the smooth glide mechanism when we move.
However, over time, wear and tear on our joints can cause degeneration of our cartilage and leave our bones rubbing close together. From this can come pain, osteophytes or loose bone fragments, swelling, and loss of motion. Arthritis can affect us all regardless of gender or age. Obviously, as we age, our cumulative use increases, but patients of all ages can be affected.
Hip and knee replacements are now commonplace in the United States, but arthritis is not exclusive to those joints. The foot and ankle are susceptible to the same type of wear and tear as any other joint, and can suffer from the same ailments. Total ankle replacement is emerging as a remedy for those with ankle arthritis but has not achieved the same type of mainstream success as hip and knee replacements to date.
One of the more common problems that present to the doctor's office these days is pain and limited motion at the great toe joint. This condition called "Hallux Rigidus" is very simply, arthritis of the great toe joint. Even though your great toe joint or, 1st metatarsophalangeal joint, is a fraction of the size of your knee, it can be equally painful and cause just as much limitation of daily activities. Your great toe plays a key role in propulsion during your gait or walking cycle and takes a brunt of the forces placed on your body during walking, jogging, and running.
Over time, the joint can begin to break down and develop stiffness, pain, and swelling. The exact etiology of the hallux rigidus beyond just normal wear and tear is a highly debated topic and much more complex than we will get into here. Our goal in this article is to provide a basic understanding of the disease and the most current treatments for it. Treatments vary greatly depending on the stage of the disease. If we are able to diagnose the symptoms early on, we can try to limit the damage with orthotic and shoe modifications as well as control pain with cortisone injections or anti-inflammatory medications. Generally, these treatments are productive for a while, but as the disease continues to progress, it becomes more and more difficult to manage the symptoms.
Over time, some patients will develop a bump on the top of the joint called an exostosis. This can cause increased pain and a decrease in motion. Once we see changes like this, surgery becomes a significantly viable option. In some patients, we can perform a cheilectomy or more simply, remove the bump from the top of the joint and clean up some of the debris we might find there. This procedure is oftentimes quite effective and successful, however, as with any surgery, proper assessment and patient selection are key.
Once the disease progresses beyond this stage and more significant erosion of the cartilage cap becomes evident, more extensive surgeries come into play. Just like hips and knees, foot and ankle surgeons replace the great toe joint. These implants are similar in structure in function, to other implants and often borrow much of the technology that has been developed from large joint replacement. The procedure is performed as an outpatient and patients are encouraged to weight bear and resume activity as soon as they can to gain as much range of motion as possible. Physical therapy and home exercises can increase success rates and aid in regaining function post-operatively.
If the disease advances to its final stages and the cartilage erosion is so significant that the bones become flattened and there is basically no motion, then the previous procedures are usually no longer options. Once we get this far along, we generally recommend fusion of the joint. Patients compensate for the loss of motion at that joint and are able to function quite well, however, there are limitations. Firstly, for women who still want to squeeze their feet into high heels and suffer the pain, this is not an option. Also, in very physically active athletic people, we try to avoid fusing the joint and find other options.
Hallux rigidus can profoundly affect a person's life, activities, and overall well-being. We are constantly trying to advance our therapies and treatments to improve outcomes and patient satisfaction. Still, this remains a very difficult condition to treat. As we always discuss, proper evaluation and patient selection are key to any successful surgical procedure so do your research and ask the doctor questions!
For more information on osteoarthritis, please contact our Long Island foot doctors at Advanced Podiatry today at either our Huntington, NY , Manhasset, NY or Roslyn, NY practice location! Or contact us through our site's request form.
