At Prairie Path Foot & Ankle Clinic, we see a lot of patients who have pain in their big toe joint. Our physicians evaluate their feet thoroughly and also take and review x-rays in order to establish an appropriate and customized plan of care. While some patients’ presentation may lead us to believe that the need for surgery is in their future, we strive to offer all possible conservative care as well.

When dealing with big toe joint pain, the initial goal is to improve our patients’ pain and function. Some very simple measures often get us off to a good start with this. No matter what severity of bunion or arthritis that there may be present, conservative treatments can offer relief of pain – in some instances even more than your physician anticipated. The longer term goal is to keep pain to a minimum and function at a level that satisfies our patients daily needs for their activities and also to slow progression of any bunion down.

If you’ve ever perused our website in the past or been to our office, you may already know that we are HUGE advocates for custom orthotics. These custom molded inserts for your shoes successfully treat a large variety of conditions. The simple reason for this in all cases is that these orthotics optimize the position and function of your feet, which results in more even distribution of your weight while walking and standing and this therefore helps to minimize overuse and stress to any one given area of your foot. When speaking about heel pain or tendinitis, this can be the solution to recurrent pain form these conditions. When it comes to big toe joint pain, the results of custom orthotic use alone can be a bit more variable – depending on the severity of the condition.

Big toe joint pain can be caused by bunions (a bump on the inside aspect of the big toe joint whereby in some instances your big toe leans over into your smaller toes) or hallux limitus (an arthritic condition that often results in a bump on TOP of your big toe joint) in most cases. So how in the world can a custom orthotic help a bunion? How can it help arthritis? And wait… can I actually get rid of my bunion with a custom orthotic?

To answer the first question – how can they help a bunion? The reason is because the custom orthotics balance the middle and hind foot to improve the foot’s position, resulting in optimized motion in your big toe joint. They also provide stability that often is lacking when you have developed a bunion. By establishing a better base to stand on, the pain in a bunion can often be improved or eliminated. In addition, because our orthotics are customized, there are a variety of modifications that can actually help divert pressure away from the big toe joint to reduce overuse leading to pain. In all honesty, this explanation also applies to the question of how orthotics help arthritis.

All that being said, the unfortunate truth is no – a custom orthotic will not reverse or correct a bunion you already have. But don’t stop reading now! As I said earlier, we have patients with a wide range of symptoms and severity with big toe joint pain. Some of our patients have a very large bunion that we see on x-ray when they are in for a completely different issue – like a broken toe and they tell us that the bunion has never been a concern for them. We also have patients who come in stating that they have terrible pain in their big toe joint and the x-rays and exam reveal only a small prominence. There is also a small portion of our patients who come in because they want to find out if they are destined to have their mother/grandmother/father’s bunion – these are the patients I wish I saw more of!

For those patients who have a small bunion, a bunion that is moderate or severe without consistent pain, or a history of bunions in their family – custom orthotics are the best treatment. For some it may even have the result that surgical correction is unnecessary! As stated earlier, there is typically instability in the foot that is present when a patient has a bunion. Treating this instability with a custom orthotic is the ONLY thing that we know has potential to slow the progression of a bunion down. Let me say that again, custom orthotics can slow down the progression of a bunion. This is an amazing thing, because let’s face it – having foot surgery is never convenient. So, if the orthotics provide pain relief and can postpone the immediate need for surgery, you have time to prepare. We have patients from all walks of life – the mother who can’t imagine having to be off her feet, the busy construction worker who needs to continue working and doesn’t have deskwork available, the patient who wants to travel with their time off rather than have foot surgery. The improved foot function with custom orthotics is the same reason that custom orthotics are a vital part of the care plan for patients who are in a position where they are moving forward with correction of their bunion. Think of orthotics being akin to wearing a retainer after having braces to straighten your teeth. We want to reduce the likelihood of recurrence of the bunion and the orthotics are critical for this.

If you have been suffering from pain in your big toe joint, please call us today! In one appointment, you can start improving pain and getting back to doing the things you love without reservation. In one visit, our doctors can provide you with information and realistic expectations on your course of care. We can discuss orthotics, show you samples and answer any questions you may have. Within just one visit, our patients with big toe joint pain can breathe a sigh of relief because there is then so much less unknown to worry about.


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