Who does it affect?
Males more common than females often no
definite cause can be found though it can be related to gout or
trauma. The symptoms are pain round the joint of the big toe,
stiffness and a bony
lump often on the top of the joint which may rub on shoes.
X-rays of the foot reveal the severity of
the arthritis within the joint.
Rest, painkillers (analgesia), an
avoidance of provoking activities, intra-articular steroid
injection and rocker bottom sole to the shoe.
Various treatment options are available:
this is a small procedure with relatively quick recovery. It
tends to improve symptoms up to about 75%, although will not
entirely eliminate symptoms. Cheilectomy tends to 'buy time'
before a much bigger and more definitive operation is required.
It can lead to some stiffening in the big toe joints.
Big toe fusion –
gold standard treatment. 5-10% non union rate however. May need
a further operation. Most patients walk with an entirely normal
replacement – this gets rid of the joint, but unlike a
fusion, keeps some movement, allowing a variation in heel
height. However the joint is artificial and can wear out with
time needing further surgery. It can lead to transfer
metatarsalgia (pain in the lesser toes). The procedure is often
only advisable in people who are retired or in those patients
who are not very physically active.
– like silastic replacement, it is an artificial joint and thus
maintains movement, however it can wear out with time. It has
only been on the market for around five years and it's long term
survival is unknown.
– in the very elderly who walk very little, the simplest
operation may be to cut out the arthritic joint and replace it
with fibrous scar tissue.