Big Toe Problems (Pathology)

Bunion

A bunion (hallux valgus) is a common foot problem in which an abnormal bony bump develops at the joint of the big toe, causing the joint to swell outward and become painful. As a result of the enlarged joint, the big toe may become stiff and turn inward. A bunion is a progressive deformity that continues to develop over time.  The more deformed the joint becomes, the more it can lead to difficulty walking and to the development of ingrown toenails, corns and calluses. It can also become difficult to find shoe wear that fits appropriately.  Although bunions are not usually a serious condition, they can be painful and unsightly. Left untreated, they will usually grow larger and more painful over time.

Depending on the severity of the condition, treatment may include over-the-counter analgesics and anti-inflammatories, wearing roomier shoes, ice pack applications, corticosteroid injections and custom-molded orthotics.  Custom molded orthotics are designed to slow the progression of the deformity.  It is important to note that the only thing that will correct the deformity is surgery, however conservative measures can reduce the pain and discomfort.

If conservative methods are insufficient to provide relief, surgical intervention may become necessary. The most common surgical procedure for bunions is a bunionectomy, during which the bony protrusion itself is removed.  However, there are many different bunion procedures available, please call our office to consult with our Foot & Ankle Specialists to determine which procedure is best for your bunion.  

Stiff Big Toe Joint

Hallux rigidus, meaning “stiff big toe,” is a type of degenerative arthritis affecting the metatarsophalangeal joint at the bottom of the big toe. This condition causes the joint to stiffen and become painful, eventually making it difficult to walk. Hallux rigidus may occur as a result of structural abnormalities, traumatic injury or underlying conditions, such as rheumatoid arthritis or gout.

There are several treatment options for hallux rigidus, depending on the severity of the condition and the patient’s mobility issues. Nonsurgical treatments include:

• Avoiding activities that cause pain, such as running
• Wearing roomier shoes
• Wearing shoe pads to limit motion of the big toe
• Wearing orthotics
• Taking over-the-counter anti-inflammatory medications
• Physical therapy
• Corticosteroid injections

If conservative methods fail to reduce pain, surgery will be necessary. Procedures performed to relieve hallux rigidus include cheilectomy, which involves shaving the bone spur; osteotomy, involving cutting bone to realign the big toe; arthroplasty, or grafting donor tissue; and arthrodesis, which is joint fusion surgery.

Hallux Varus

Hallux varus is a condition in which the tip of the big toe points inward. It is different from a bunion, which causes the joint to swell outward. A hallux varus does not typically produce pain until shoes are worn that irritate the toe and result in friction. The deformity may be due to a congenital abnormality in the foot, trauma or, most commonly, an overcorrection during a bunionectomy.

Conservative therapies can provide effective treatment for a hallux varus and may include the use of over-the-counter anti-inflammatory medication, corticosteroid injections, wearing roomier shoes or use of an orthotic. If these methods do not adequately relieve discomfort, surgery may be recommended. The procedure performed varies depending on the extent of the deformity and its cause, but may involve tendon transfer, sesamoidectomy or osteotomy.

Sesamoid Pathology

Sesamoiditis is an inflammation of two small bones, called sesamoids, situated below the metatarsal joint of the big toe. The sesamoids protect tendons and help stabilize the foot during walking.

These two small bones are subjected to great pressure and are especially vulnerable to high-impact activities such as athletic pursuits or ballet dancing, and to occupational stress from repeated squatting or heavy lifting. They frequently suffer damage in the form of inflammation or stress fractures.

Typical treatments for sesamoiditis are designed to reduce swelling and pain and may include resting, icing the affected region and taking oral anti-inflammatory medication. Long-term methods of treatment, employed both to provide pain relief and to prevent recurrence, include wearing well-padded shoes or orthotic inserts and engaging in physical therapy. In more severe cases, surgical removal of the affected sesamoid may be necessary. If the inflammation is caused by a fracture, casting may be necessary for a period of up to two months.

Turf Toe

Turf toe, a sprain of the soft tissue in the main joint in the big toe, is a common sports injury. Turf toe is usually caused by jamming or pushing the big toe while running or jumping, which results in swelling, pain and limited joint movement at the base of the toe. Typically, the injury to the toe is sudden (a “pop” may be felt), although it sometimes develops gradually after repeated trauma.

At-home treatment using RICE (rest, ice, compression, elevation) is often sufficient to promote healing and reduce inflammation. Over-the-counter anti-inflammatory medications are usually recommended until the pain and swelling subside. The only time surgery is necessary for turf toe is if the bone is chipped or the ligament is completely torn.