Painful big toe arthritis - what can be done to help?

What should you do if you have pain in your big toe that isn’t going away? Could it be a sign of arthritis? If so, what can be done to help? We spoke with leading orthopaedic surgeon and specialist in foot and ankle problems, Mr Matthew Solan:

If you have pain in your big toe that isn’t going away, there are several possible causes. The symptoms you suffer and the appearance of your toe differs slightly depending on the cause:

• Bunions - a bunion forms when the big toe slips off its knuckle bone. This may make the joint prominent, the toe look bent and the foot ache. Progression is usually gradual.
• Gout – typically very painful, red and swollen. Painful at rest.
• Sports injuries – fractures or ligament damage with injury; more gradual pain from pressure under the toe joint.
• Arthritis - if the big toe joint develops arthritis it usually stays straight but becomes swollen, stiff and painful.Gradually deteriorating stiffness and pain are the most common symptoms you’ll experience.

Who to see about big toe arthritis

If you suspect you might have big toe arthritis, or you’re unsure, you should visit your GP. They may ask you to have an x-ray, to check for joint deterioration. If arthritis is detected, a specialist may request a scan. This can show the severity of the arthritis and help decide upon the right treatment.

What home remedies can help?

There are a number of things you can do yourself to help with the pain:

• Make sure you wear comfortable, well-fitting shoes. These should give proper support to both your heel and the ball of your foot. Insoles may also help with this.
• Pay close attention to which activities provoke the pain and try to avoid those.
• Calf stretches may prove helpful, but exercises for the toe itself can be counterproductive, so care is required.

Long term pain killers are best avoided, since even over the counter medications have side effects.

Is there a surgical procedure that can help?

Surgery is, of course, a last resort. There is the inconvenience of recovery to consider, and also small risks from any operation. It is, therefore, wise to try all other options first.

In selected mild cases, an injection, sometimes combined with a joint manipulation, will give worthwhile relief.

If the joint is completely seized up and painful, then fusing it shut – with the use of pins – is a good operation with very high success rates. The main toe joint never moves again (this is not significantly disabling, despite how drastic it sounds) but the pain relief is excellent.

Ideally, of course, we’d like to preserve the movement at the joint as well as achieve pain relief. An operation to clean up the joint and remove bony spurs (called a cheilectomy) works well for many patients. In some, where there are not just spurs but also bare patches inside the joint, a special rubber spacer provides a new smooth surface. This is called a Cartiva arthroplasty operation. Although not suitable for everyone, this operation is now widely used, based on the successful, award winning, scientific studies undertaken by surgeons in the UK and in Canada.

If you’d like to discuss pain in your foot with Mr Matthew Solan, click here to book a consultation.