Pain and stiffness in the big toe joint without being able to bend it?
Hallux limitus/rigidess also known as “turf toe” is a common arthritic condition affecting the great toe joint. The cartilage of the great toe becomes eroded, leading to limitation of motion and eventual rigidity. Most patients will complain of pain and stiffness in their big toe, especially after sports, wearing high heels or daily activity. Causes of turf toe range from a long first metatarsal, prior traumatic injury, elevated first metatarsal, previous surgery or family history. It is very important to determine what exactly is causing the arthritic condition when treating turf toe otherwise the surgery will not be successful.
Treatment of turf toe
Conservative care in treating turf toe ranges from stiff soled shoes, orthotics, cortisone injections, and icing. Once pain is present daily and your activities are limited, surgery should be considered. Surgical treatment is varied, but it needs to be aimed at removing the deforming force on the great toe joint and what stage of arthritis is present in the great toe joint. It’s important to see a doctor who doesn’t do one surgery for every bunion because each patient is so specialized that doing the wrong procedure could hurt their results.
- Cheilectomy is used in mild cases and removes bone spurs from one or both sides of the big toe joint. Patients can immediately weight bear and it will allow for a quick return to activities.
- Hemi joint implants are used in moderate arthritic cases. The implant will replace arthritic bone and damaged cartilage, which will improve patient’s range of motion and decrease their pain tremendously. Post operatively patients can immediately weight bear in a surgical shoe. A unique procedure that is employed at the Foot, Ankle & Leg Vein Center includes a joint resurfacing technique of the damaged cartilage inside the joint.
- Total joint implants are used in moderate to severe cases. Bone is resected from both sides of the joint and the entire joint is replaced by an artificial implant. Patients again will return very quickly to activity with predictable results from these procedures.
- Decompression osteotomies, or bone cuts, are used when patients have long first metatarsal bone and minimal arthritic changes of the joint. The purpose of this procedure is to make room so the great toe joint function properly.
- Distraction diastasis of the big toe is a surgical procedure when the big toe joint is stretched out to provide more motion. An external fixator is applied and slowly distracted. It is kept in place for several weeks and then removed after the soft tissue has stretched out. Stem cell injections are used in conjunction with the soft tissue stretching.
- Arthrodesis of the great toe joint is a fusion of the two bones of the joint and is used in severe cases and previous failed operations. A fusion of the big toe joint involves surgically removing the arthritic cartilage/bone of the joint and mending the bones in a functional position for the foot. The surgery is excellent in removing pain, however the patient will not be able to move their big toe joints. Women will have limitations in shoe height and may have difficulty wearing high heels. The best surgical procedure for your turf toe will be determined after clinical evaluation and x-rays at the Foot, Ankle & Leg Vein Center.