What is it?
Arthritis (osteoarthritis) is a gradual and debilitating breakdown of the body’s joints due to routine wear and tear, overuse and mechanical abuse. The big toe is a key joint in the foot which, because of the high repetitive forces that pass through it with all weigh-bearing activities, is unusually susceptible to arthritis in middle age and older adults.
Arthritis features a number of negative changes to joint tissues and function. The most important change is the thinning and eventual disappearance of joint cartilage. Cartilage is the smooth, lubricated surface at the ends of the bones in all normal joints that is responsible for normal function. It allows the joint to move smoothly with minimal friction and is capable of handling large compressive forces without pain or damage to the joint. It has no nerve endings so even heavy loads are not usually painful. When a joint is subject to routine, abnormal wear and tear or unusual mechanical strain, the cartilage may be worn thin or obliterated completely. The cartilage develops cracks or fissures, loses its lubrication and the cells gradually die. The involved joint becomes swollen and painful; excess bone frequently develops along the joint margins (called “lipping”) as a response to the abnormal trauma and tends to progressively limit joint range of motion as the arthritis advances.
In advanced stages of the disease, the upper joint line shows significant bone “spurring” that looks like a large bump at the top base of the big toe. This bump will frequently be rubbed raw against the shoe becoming red and swollen. The joint will eventually become very stiff and painful.
How did I get it?
The big toe is designed to take the majority of stress as the forefoot loads and we propel ourselves forward with each step. When the main arch of the foot flattens (flat feet), though, the big toe function becomes limited by abnormal ligament restraint. The toe cannot raise upwards when the forefoot is loaded but the forward motion of the foot occurs anyway, forcing the joint into a position it cannot assume freely.
This forcing of the big toe motion is abnormally stressful to the joint. Over time, the joint begins to show the negative changes of arthritis described above, The base of the big toe becomes thicker, begins to swell especially after prolonged weight-bearing activities, and gets progressively stiffer and painful with age. Bad weather may elicit soreness in the joint because it promotes swelling.
Besides poor foot mechanics due to flat feet (most common), arthritis of the big toe may come from a sports injury, a traumatic accident or the medical condition known as gout.
How is it treated?
Arthritis is best treated in its early stages before the joint loses most of its range of motion. As with most foot problems, there are two main concepts in treatment: 1) reduce the symptoms, and 2) address the underlying cause.
These may include ice and oral anti-inflammatory medications. These may provide some temporary relief and ease the pain of inflammation, but are not helpful in addressing the underlying cause of your condition.