Osteoarthritis of the big toe

What is osteoarthritis of the big toe?

Your big toe joint is called the 1^st metatarsophalangeal joint. There are many reasons why someone can develop pain in this region. One of the more common problems is osteoarthritis. Not everyone who has arthritis will suffer with symptoms, but those that do can experience pain, stiffness, reduced mobility and function.

The experience of big toe osteoarthritis is often unique to each individual but often people with symptomatic osteoarthritis report stiffness in a morning, pain during activity such as walking or going onto your tip toes. There is usually reduced movement to the joint and sometimes the toe can angle over towards your second toe. Some people may also experience “crepitus”. This is a crunching or cracking noise or feeling that usually isn’t anything to worry about.

Contrary to popular belief, osteoarthritis is not caused by ageing and does not necessarily deteriorate with time. At the end of each bone we have a type of cartilage known as hyaline cartilage. Osteoarthritis is the localised loss of this cartilage (“tear”). This is associated with inflammation (“flare”) and bony remodelling (“repair”). Bony remodelling is normal and is not correlated with symptoms. You can have a large amount of remodelling and no pain or you can have barely any remodelling and have severe pain. This remodelling explains why some people get crepitus. As your joints repair themselves through your lifetime, their shape and structure can change slightly which can lead to crepitus.

Self Help

 

The following modifications may help your symptoms to settle:

• Wear wide comfortable shoes with a firm sole. This may reduce the amount of bending or pressure through the big toe joint when you are walking
• Initially, give your toe an opportunity to settle by modifying or reducing painful activities where possible. Temporarily reducing or modifying activities that reproduce your symptoms may help the symptoms settle. E.g. if you notice your symptoms are worse when running, try reducing the amount you do for a short period.
• Weight loss – Having a higher than normal body mass index (BMI) is associated with osteoarthritis. It is thought to be due to the 'switching on' of inflammation by a group of chemical messengers called adipokines. These chemicals are released by fat tissue (we have higher amounts of these chemical messengers in our bodies if we are overweight). In addition, reducing your weight will also reduce the amount of pressure through your foot. Further information on weight loss can be found here
• Medication – National guidance recommends paracetamol or NSAID’s for the management of osteoarthritis - Please check with a pharmacist or your GP if either of these medications is appropriate for you.
• Exercise – try to keep the big toe joint flexible. Please see the videos below for examples of some exercises that might be helpful

If you experience a flare of symptoms this is usually linked to an episode of inflammation within the joint. It is therefore usual for a flare up to last between 6 and 12 weeks. If you are struggling with a flare it is worth considering medication for managing this. Your GP may prescribe you a short course of medication to help with the flare up. You should also make sure your following all our advice above with regards symptom management.

Further Treatment

 

If self-management fails to improve symptoms, other possible treatments include:

• Podiatry referral - If you are struggling to return to your normal activity levels or your foot is not settling, ask your GP for a referral to podiatry. Please note, you cannot refer yourself to podiatry via this website.
• Steroid injection - If you are and you are experiencing a very persistent flare which is failing to settle with other conservative treatments a corticosteroid injection into the joint may be helpful to settle things down. An assessment would be required to assess if this is an appropriate treatment option for you.
• Surgery – The decision on surgery is multi-factorial. An assessment would be required to assess if this is an appropriate treatment option for you.

If you are struggling to return to your normal activity levels or your big toe is not settling and would like a further assessment, ask your GP for a referral to the Musculoskeletal service or fill out our self-referral form here.

Please Note: If you have diabetes and are experiencing a new onset of pain or sensation change in your feet we advise you see your diabetic nurse or GP in the first instance prior to referral to the Musculoskeletal Service.