Big Toe Arthritis - Variants of a Bunion

This is by far my most favorite topic to discuss with patients...bunion pain and its variety. What are the varieties? This is what I will focus on here.

Typical presentation: A patient presents with a bumpy joint pain by the big toe (hallux) and believes it is a bunion. States it seems to be getting bigger with time and that it hurts with walking and certain shoes. They'd like to know treatment options to alleviate the pain. 

An office consultation will consist of clinical exam and xrays.

 This patient had pain for many decades and what is shown is abnormal bony growth around the first metatarsophalangeal joint. Normal joint should look pearly and smooth, the above shows irregular ridges and loss of articular cartilage. 

This patient had pain for many decades and what is shown is abnormal bony growth around the first metatarsophalangeal joint. Normal joint should look pearly and smooth, the above shows irregular ridges and loss of articular cartilage. 

You can already see what option we went with in this particular patient. I call this the "bunion variant" because that's what most people will think they have in this area when in fact it is arthritis. The bumps in the first joint is really a build up of bone that occurs with long term use of wear and tear. Some people's anatomy are set up for this type of pathology as they get older, while many others will never have this problem. The biomechanics of the foot is incredibly amazing but that's not what I'll discuss here. I'm sure what you really want to know are what are the treatment options when you get arthritis in this joint, right?

Nonsurgical options (conservative):
- Activity modification
- Better supportive shoes
- Inserts (also called orthotics - can also get these custom made)
- Pain medication or steroid injections

Surgical management (when all else has failed to provide adequate relief):
- Shaving off the extra bone (cheilectomy)
- Cutting bone, shifting it and securing the new position with screws in a better anatomic alignment (shortening osteotomy)
- Joint replacement (like knee replacements but much smaller)
- Joint fusion (most definitive for end stage arthritis where the joint it already stiff, this procedure eliminates the pain - many people don't miss the motion in the joint anyway at this point)

As much as I enjoy performing surgery, many people do quite well with conservative management. But know that you don't have to live with pain forever. Consult your nearest foot and ankle specialist to discuss which option will be best for you.