Arthritis of one or more of your toes refers to damage to the joints cartilage which is the smooth covering on the end of the bones. The cartilage is responsible for helping the bone ends glide over one another smoothly and absorb shock. Arthritis occurs when the cartilage becomes worn out, degrades or is injured as a result of previous trauma leading to deterioration of the joint surfaces. Arthritis also involves inflammation of the lining of the joints called the synovium.
Symptoms of Toe Arthritis
If you have toe arthritis, you may experience:
- Pain around the joint effected that gets worse on bending the toe. This usually occurs with activities like walking, so as the toe bends during walking you will notice the pain.
- The joint may be swollen and red and can ache at rest once aggravated.
- As the condition progresses, you may notice the joint doesn’t bend as much as the adjacent toes or the same toe on the other foot.
- If a bony lump develops on one of the bone ends (called an osteophyte), it may rub in certain footwear and become painful.
Causes of Toe Arthritis
Arthritis most often occurs due to repetitive cumulative micro trauma ie wear and tear with time. It is a normal ageing process and most joints will have some degree of degenerative changes as we age. The reason why certain joints wear out faster than others is usually due to biomechanics. If you are loading that specific joint more regularly, then it will wear faster.
The other causes of arthritis may be due to a previous trauma like a fracture or significant sprain to the joint ligaments. Once a joint has been damaged in some way from an injury, it is more likely to develop degenerative changes over time as the joint now moves in a different way to its neighbouring toes.
Toe joints are hinge joints meaning they work in much the same way a hinge does: they bend in one direction. The town bone ends are covered with smooth hyaline cartilage which helps shock absorption and gliding of the bones. Either side of the joint there are ligaments (collateral ligaments) to stop the toe ending to the side and stabilising the joint. There is another structure that runs between the bone ends under the ball of the foot. This is called the plantar plate. It stabilises and protects the joint on the weight bearing surface. Injuries to the plantar plate may also mimic toe arthritis.
How to diagnose
Often arthritis is diagnosed on x-ray. However, toe joints are small and subtle changes in joint surfaces may not always be picked up using this method. MRI is the gold standard for detailed analysis of joint surfaces, however ultrasound imaging is much more cost effective and quicker to give you a glimpse of joint health. With Ultrasound, we can see the edges of the bones to look for osteophytes and assess the joint lining (synovium). Manual examination will pick up any joint flexibility issues and we will also look for any redness and joint swelling. Location of the pain is also important as a tenderness over a specific joint will guide our assessment and diagnosis.
Most toe arthritis can be treated conservatively with Physiotherapy.
Treatment may involve footwear modification to a stiffer soled shoe or rocker bottom shoe, manual therapy and exercises.
- Appropriate footwear.
Wearing a shoe with a stiff sole will limit the toe from bending back when walking. Rocker shoes such as the Hoka 1 trainers, allow you to roll over rather than push through the big toe. It’s important to wear shoes that have plenty of room for your forefoot and toes and to avoid wearing high heels or pointy shoes.
- Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can reduce pain and inflammation.
- Over the counter gels that can be good for reducing inflammation in toe arthritis.
- Manual therapy and exercises to reduce stiffness and pain in the big toe joint. As well as increasing strength in the foot.
- Weight loss may help if you are overweight, as this will result in less stress going through the big toe joint.
- Taping can be used to help stabilise the joint to tolerate weight-bearing activities.
If pain persists, then we can explore other treatment options outlined below.
Ultrasound-guided Steroid injection
An Ultrasound-guided steroid injection into the toe joint is used to reduce pain and inflammation. It is suitable if you have not responded well to previous interventions and NSAIDs have not helped the swelling and pain. After this treatment, we may still advise you off-load the joint with certain footwear or taping to give the steroid the best chance at reducing the inflammation.
This can also be coupled with Hyaluronic acid injections but will depend on the size of the joint and long term goals.
Hyaluronic acid injection
Ultrasound-guided Hyaluronic acid injections are used to treat mild to moderate osteoarthritis. If a steroid injection is not right for you, or you wish to try non-steroidal options, then Hyaluronic acid is an excellent place to start. It is not a drug so will not cause any interactions with other medications you take. It may also last longer than a steroid injection. It is not as powerful in terms of reducing inflammation however, so if you are in more pain, it may be worth combining with a steroid injection either at the appointment, or 1 week apart.
Those who do not respond to the above treatment interventions and have more advanced stages of toe arthritis, may want to consider surgery.
If you are experiencing symptoms similar to those described above and want to find out what is causing your pain, please get in touch and one of the team will assess, diagnose and advise on the best treatment option for you. Please contact us on 0207 636 5774 or email email@example.com