Arthritis in your big toe (metatarsal-phalangeal joint)

The most common cause of chronic joint pain in your big toe is osteoarthritis. Also known as wear and tear arthritis, osteoarthritis is the most common form of arthritis. It happens when the smooth cartilage that protects our joints gradually wears down over time. This leaves our joints with less cushioning and protection and can allow our bones to rub together, causing further damage to the joint.

Big toe arthritis happens when the main joint in your big toe is damaged in this way. This is your first metatarsophalangeal joint (or first metatarsal-phalangeal joint), named so because it connects your metatarsal bone (forefoot bone) to the first bone in your big toe (the proximal phalanges). You might think of this joint as your toe knuckle.

The most common cause of osteoarthritis is simply natural wear and tear as we age, though other factors that can increase the likelihood include:

• Previous injury or trauma to the joint
• Previous damage to the joint from a condition such as gout or rheumatoid arthritis
• Being overweight (which puts more pressure on your joints)
• Family history of the condition
• Poor ankle-foot alignment, for example flat feet

Big toe joint pain

Pain in your joint is a common symptom of big toe arthritis. You will usually feel pain across the top of the joint and you might also have pain at the base of your big toe.

This pain might get worse when you've been on your feet a lot, or when you wake up in the morning.

Stiffness in your big toe

A stiff big toe is another common symptom of MTP joint arthritis. You might not be able to bend your toe upwards and the overall range of motion in your toe might be significantly reduced.

Swelling in your big toe

A swollen big toe joint is quite common with this type of arthritis, and can add to the stiffness and lack of mobility in your MTP joint. This might be accompanied by a bony lump known as a dorsal osteophyte that grows on the top of your big toe knuckle.

Although your symptoms might be mild at first, and many people find they can live quite happily with big toe arthritis, in the long term your pain, swelling and stiffness might continue to get worse. If this is the case, MTP arthritis can start to impact your quality of life. At this point, it's time to see a specialist.

Your consultant will start by asking you lots of questions, about your medical history, your symptoms and how your big toe problems are affecting your life, and whether you’ve had any treatment already for the problem. They will want to know as much as possible about you, and about what you are hoping to gain from treatment, so that they can treat you in the best possible way for you.

There will be a short physical examination of your foot, which is often enough for your consultant to make a diagnosis of arthritis. They’ll want to check for swelling, examine your range of movement, and assess your pain levels.

You won’t usually need additional tests or scans, but in some cases we might arrange an X-ray. This is typically only done if your consultant thinks that surgery is the best option.

Although our foot and ankle specialists are consultant surgeons, they will not usually recommend surgery unless non-surgical methods have been exhausted first. So, although you might book an appointment with a foot surgeon, they won't suggest surgery on your big toe unless it's the right choice for you.

Comfy footwear or orthotics

For many people, big toe arthritis can be managed simply by wearing comfortable and supportive footwear. You could try wearing wide fit shoes so that there's less pressure on your toe joint. And avoid high heels, which can exacerbate your symptoms.

You might also want to speak to a specialist about orthotics, perhaps custom insoles, which might be able to offer further support to your foot.

Physiotherapy

A physiotherapist will provide you with specific exercises that can help maintain flexibility in your ankle and foot, and could help to build up the muscles in your foot so that your big toe is more supported.

Pain medication

Over-the-counter painkillers, such as paracetamol, and anti-inflammatory medications, such as Ibuprofen, can be effective in the early stages of MTP joint arthritis. Speak to your doctor or pharmacist about which they would recommend.

Steroid injections

Corticosteroid injection therapy relieves pain and reduces inflammation in the joint. These are just one type of joint injections that can be used to treat arthritis.

Big toe cheilectomy

This is an operation to remove the bony lump (dorsal osteophyte) that sometimes grows on top of the big toe in cases of MTP joint osteoarthritis.

Metatarsophalangeal joint debridement surgery

Joint debridement surgery involves removing bits of loose bone, tissue and cartilage from inside your damaged joint. This can significantly reduce pain and improve mobility.

Foot fusion surgery

Foot fusion surgery is where certain bones in your foot are permanently fused together. This stops the pain that happens as a result of bones in your joint rubbing together.

MTP joint replacement surgery

Metatarsophalangeal joint replacement surgery replaces your damaged big toe joint with an artificial joint, known as a prosthesis or implant. The operation can reduce your pain and improve the range of motion in your joint.

Recovering from surgery for big toe arthritis

Recovery will vary depending on the type of foot surgery you have, as well as factors personal to you, such as your age and weight, and your general fitness levels. Typically, it will take between three and six weeks after toe surgery before you can stand or walk for long periods of time.

You will usually have to take at least a week off work, many people will need four weeks off, and if your job involves being on your feet a lot, you'll need significantly longer.

Two to three months after surgery, most people are back on their feet and have returned to their usual activities.

• Flexible appointment times and locations to fit your routine
• The freedom to choose which hospital and consultant suit your needs
• Personalised, consultant-led treatment plans tailored to you
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms as standards and delicious healthy meals
• Affordable, fixed-price packages with aftercare included
• Flexible payment options to help you spread the cost of your care

If you would like to learn more about treatment for arthritis in your big toe, book your appointment online today or call a member of our team directly on 0141 300 5009.

1. Big toe arthritis, NHS
2. Osteoarthritis, Versus Arthritis