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Big problems for big toe joints

Big toe joint problems aren’t fun, as many people know from personal experience. Red, swollen, or misshapen joints can be unsightly. Still worse, though, is the pain –– and sometimes the risk of immobility –– that accompanies big toe joint problems. Fortunately, you can take some simple steps to help relieve pain and keep you from slowing down.

Big toe 101

The big toe has two joints, but the one most vulnerable to problems is the metatarsophalangeal (MTP) joint. It connects the first long bone (metatarsal) in the forefoot to the first bone of the big toe (phalanx).

The MTP joint bends with every step you take, so you can push off and let the other leg move forward. But the poor MTP joint takes a beating during that process, supporting half your body weight for a brief moment as you push off.

Osteoarthritis

A common consequence for the MTP joint is osteoarthritis, the wearing away of cartilage at the end of the bones. It often shows up starting in middle age. Without cartilage, the space between bones decreases and the bones rub against each other. This can cause pain and lead to painful growths called osteophytes or bone spurs.

Osteoarthritis can also cause a loss of flexibility in the MTP joint, a condition known as hallux rigidus.

But MTP arthritis isn’t always painful. “Often, big toe arthritis doesn’t cause symptoms. We commonly see people come in for other problems and then we see arthritis on an x-ray,” says Dr. Christopher Chiodo, chief of foot and ankle surgery at Harvard-affiliated Brigham and Women’s Hospital.

If MTP arthritis doesn’t hurt, your doctor may recommend that you simply avoid wearing high heels, if you wear those, and instead wear stiff-soled shoes to reduce the motion of the MTP joint.

Treatment comes in if there’s pain. In that case, Dr. Chiodo often prescribes a carbon-fiber base plate to insert inside the shoe and decrease joint motion. “And some patients have relief with a rocker-bottom shoe,” he adds.

Surgery to remove bone spurs, clean out the arthritic MTP joint, or fuse the bones is a last resort. Dr. Chiodo says it may be necessary if

  • you have daily pain that’s lasted for more than three months
  • the pain interferes with your daily activities
  • and you haven’t responded to nonsurgical options.

Bunions

Family history and tight shoes with narrow toe boxes (like high heels) may play a role in creating a bunion. If you have a bunion, the first metatarsal bone juts outward at the joint, causing the phalanx bone to point inward toward the other toes. “Compressing the toes together over years weakens the ligaments that hold the toe in a straight position,” Dr. Chiodo explains.

If bunions don’t hurt, avoid surgery, Dr. Chiodo recommends. “You can wear shoes with a wide toe box or stretch your shoes to make room for the bulging MTP joint,” he says. You’ll also want to avoid wearing heels, which continue compressing the toes together.

If your bunion hurts, surgery aims to realign the bones of the foot so the big toe is in a straight position. “Sometimes we have to cut the bone and reset it, and sometimes we have to fuse it,” Dr. Chiodo explains. Afterward, you may have to wear a special shoe or boot and avoid putting weight on your foot for six weeks.

However, a surgical fix doesn’t always last. “Bunions can recur. It’s one of the most common complications. Wearing shoes with a narrow toe box will increase the chance that this happens,” Dr. Chiodo warns.

What you should do

If MTP joint pain is interfering with your mobility, see your doctor. You may or may not be looking at surgery down the line. Only your doctor can make that call.

Otherwise, get smarter about footwear. Skip heels and wear stiff-soled or rocker bottom shoes. It’s an easy fix that can lead to something really beautiful: maintaining your mobility and walking around without MTP joint pain.

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