This is arthritis of the big toe joint (metatarsal phalangeal joint) which is graded by it’s severity: Stage 1 – Mild arthritis with inflammation, swelling and some pain which is usually not constant. Stage 2 – Moderate arthritis with a limitation in the range of motion of the big toe joint and aggravated with activity and high heels. X-rays will show spurring and some loss of joint space. Sesamoids can be affected. Stage 3 – Severe arthritis with almost complete loss of joint space on x-ray and constant pain. Sesamoids are almost always involved. Stage 4 – No joint space.

Treatment Options:

Stage 1 – NSAIDS, Rx Topical Medication, Laser, ICE and Orthotics management. Stage 2 – Same as Stage 1 but if fails may consider injection of Amniotic fluid (insurance usually won’t cover this) Surgery in the form of a cheilectomy, which is a removal of the arthritis/spurs by removing it with surgical equipment. Not always definitive. Also may consider an osteotomy of the metatarsal or phalanx depending upon the structure of the foot. Stage 3 – Can try amniotic fluid injection but this will not cure it, may last for 6 months to a year. Can inject over and over if you like this treatment. Surgical-osteotomy of bone to shorten or lower with or without implant. Implant into one side of the joint or both. This is surgeon preference based on patient activity level and x-rays. Fusion is an option as well but this will cause permanent loss of motion to the joint but will relieve all pain in 95% of patients. Stage 4 – Fusion or Implant.

Post Operative Courses for Above Surgical Options:

Cheilectomy – 48 hours stay off foot and elevate and ice. PT. Dynasplint (medical device to wear at home covered by insurance) Then wear boot for 2-3 weeks, then back in sneakers till 6 weeks or so then regular shoes to tolerance. We recommend post op cold laser treatment to speed recovery. Topical pain meds. Osteotomy With or Without Implant – Stay off for 48 hours completely, elevate and ice. Wear cam walker boot for 4-6 weeks. PT and Dynasplint. Topical pain medication, cold laser therapy. Back in regular shoes around 8-10 weeks. Return to full activity around 3-4 months depending on activity level. Can swim or do stationary bike after 4-6 weeks. Implant – 48 hours ice and elevate, start walking in cam walker boot for 1-2 weeks then wear sneaker at 3-4 weeks will depend on swelling. Return to full activity in 6-8 weeks. Laser, topical cream and PT and Dynasplint post op.