The most common site for degenerative arthritis on the body is the thumbs. The second most common site is the big toe. It makes sense, doesn't it? The big toe is just the thumb of the foot! They are the two joints that we use more than any other in our day to day lives. Add in the fact that our entire body weight goes across the big toe when we are walking, degeneration can occur in this joint starting as early as our late 20s to early 30s. Running, shoe gear, athletics and injury can all lead to increased rate of degeneration in the joint.
Another risk factors that can lead to degeneration in the 1st MPJ (Big toe joint). Overpronation can cause the first metatarsal bone to push up and cause a "jamming" of the joint limioting motion and damaging cartilage. This can lead to functional limitations in the joint. In the case of functional degenerative changes, orthotics can help to allow more natural motion across the joint. Steroid injections may also be used to reduce inflammation in the joint. Surgical considerations for this problem may include shortening the bone to disimpact the joint, joint implants to help increase mobility or fusion of the joint.
We can also get structural problems from the degeneration of the joint. Damage to the cartilage can cause joint space narrowing, spurring and hardening of the surrounding bone. These degenerative changes can also limit the motion of the toe, causing additional pain. Injections of steroid and orthotics may be helpful in controlling this condition without surgery. In cases of mild to moderate degenerative changes, a procedure to remove the bone spurs and clean the joint may be perfomed in order to relieve pain. In more extreme cases, joint implant or fusion may be recommended to help with pain and functionality.
Some more recent inovations in surgery include cartilage grafts and amniotic therapy. Amniotic grafts may be used as part of a joint cleaning procedure to help repair carilage damage and act as a buffer for the toe joint. Amniotic injections can also be helpful in reducing pain and increase functionality of the joint.
It is important to know that we treat these arthritic changes based on what our patients desired activity and outcomes are. Conservative care with orthotics, injections and NSAIDs can be just as effective as surgical correction for some patients. Other patients may require surgery to help reduce their pain.
Chris Suykerbuyk, DPM, FACFAS.