Monday Medical: Addressing arthritis of the big toe |

Monday Medical: Addressing arthritis of the big toe

Susan Cunningham
Monday Medical

Pain in the big toe may be more common than you think. The big toe is the area of the foot most commonly affected by arthritis, which is a common source of pain and stiffness in a joint.

“We end up seeing it frequently,” said Dr. Alejandro Miranda, an orthopedic surgeon in Steamboat Springs and a member of the medical staff at UCHealth Yampa Valley Medical Center. “Arthritis technically means joint inflammation or pain, but we often think of it as wear and tear of the joint surface. In the big toe, it is medically diagnosed as hallux rigidus.”

Since that wear and tear happens naturally over time, arthritis of the big toe usually impacts older patients. But younger patients aren’t immune, as the issue can be brought on by trauma or stress to the joint, and genetics.

“Not too uncommonly we will see people in their 30s present with arthritis of the big toe,” Miranda said. “It may be that they were more susceptible or that they somehow traumatized that joint.”

Symptoms include pain, stiffness and swelling.

“In the early stages, people may feel their footwear applies more pressure than it used to. As the joint stiffens, mobility lessens and it becomes harder to put on boots or shoes,” Miranda said. “Another early sign is pain with physical activity.”

Initial treatment options include wearing spacious shoes to accommodate the enlarged joint and using stiffer shoes or insoles. Taping techniques can also be used so the affected joint doesn’t have as much range of motion.

“You’re more or less splinting the injured joint, and because of that, a lot of people will feel some relief,” Miranda said.

Oral and topical anti-inflammatories, as well as physical therapy, may also help with pain.

Exercises that heavily load the toe, such as weighted lunges and burpees, may exacerbate the issue, so Miranda encourages patients to tailor their workouts accordingly.

If those initial efforts don’t help, a steroid injection in the toe, done under X-ray guidance to ensure the steroid gets into the joint, can help quiet down the joint space and alleviate pain. But eventually, surgery may be considered if nonoperative treatments fail.

“Once conservative treatments stop taking effect and as the pain becomes more limiting, we start thinking about surgical options,” Miranda said. “The goal is always to find what’s right for each individual to get them back to doing what they like to do.”

In general, three types of surgery may be considered: bone spurs that impinge the joint and cause pain can be shaved away; synthetic implants or tissue can be interposed in the joint to restore joint spacing; and finally, the joint can be fused.

“Fusing the joint converts a diseased and painful stiff joint into a painless stiff joint,” Miranda said. “For the person who has debilitating pain and symptoms in which their joint is stiffened already, you’re helping them by making it painless.”

Patients may worry that fusing the joint will make it harder to return to activities, but in fact, people are still able to hike, run, ski and do labor-intensive jobs.

“Certainly, some modifications need to be made – some people end up selecting different footwear or different types of boots – but most people do get back to most of their activities without pain,” Miranda said.

Miranda encourages people who are having pain and stiffness in the big toe to seek an evaluation.

“Arthritis is only one of the diagnoses that causes pain in the toe. Seeking an evaluation can shed light on the source of pain, and help determine next steps are for pain relief,” Miranda said.

Susan Cunningham writes for UCHealth Yampa Valley Medical Center. She can be reached at

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