When you think of arthritis, you think of aches and pains in your bigger joints - maybe your knee or your back or your hip. However arthritis can affect all joints, even the joints in your toes. Our patients come to us with foot and toe pain, and our doctors narrow it down to a specific area or joint or even toe. And after a thorough exam and digital Xray on site to rule out injury or trauma to the toe and also rule out infection, we can assess if the toe pain is in fact stemming from any type of arthritis.
One of the most common areas of the foot to have arthritic issues is the big toe. The big toe is referred to as the hallux, and the hallux attaches to the foot at the long bone of the foot called the metatarsal. The first metatarsal joint, or the big toe joint where the hallux meets the foot, is often inflamed in different arthritis conditions. One of the most common is osteoarthritis (OA), or degenerative joint disease of the big toe. DJD of the big toe joint has a very specific name, it is hallux limitus or hallux rigidus. This occurs when the big toe joint rubs up against the end of the first metatarsal bone, and you may see swelling in the big toe joint and even redness. Many times you will see a "bump" on the top of the foot that does not go away, and it may sometimes even rub up against the top of your shoe. The reason it is referred to as hallux rigidus is because of the arthritic changes in the big toe joint, the big toe has limited flexion and feels very rigid. Sometimes it may even hurt to try to bend the big toe joint up. This is not helpful for those of you who like - or need - to have flexible big toe joint for yoga or sports. If you look at a radiograph, or X-ray, of the foot, you can often see joint changes such as extra bone either within the joint or at the top of the foot. Treatment for this condition can be conservative, with custom orthotics and range of motion exercises, or even our MLS laser to decrease the swelling. Patients may progress to an oral anti inflammatory prescription. Another alternative is a cortisone injection, but the injection may give temporary relief because it doesn't actually address the cause of the pain, which is the extra bone and lack of joint space. Some of our patients may progress to surgical intervention, which addresses both the extra bone and decreased joint space.
A second but less common cause for arthritis in your toes is actually gout. Gout is considered a type of arthritis because it affects the joint. In the foot, the big toe joint is the most affected. Gout is the increase of concentration of uric acid in the blood. This can happen for two reasons, either your body produces too much (over producer) or the body does not excrete enough (under secretor). Either way, the increase in blood uric acid levels allows the deposit of uric acid into the big toe joint of the foot. This causes a red, hot, swollen big toe joint and is extremely painful. Treatment includes a very strong anti inflammatory medication, and a medication called colchicine that decreases the buildup of uric acid in the joint. A patient's diet can also contribute to levels of uric acid, so your doctor may suggest a certain diet to keep away from certain foods (including red meat or alcohol) until the uric acid levels become normal. In addition, your primary care physician may prescribe a medication to decrease your uric acid level in the long term. On X-ray, in a person who has long standing gout, there are changes in the joint that can be seen.
Another type of arthritis that can manifest itself in the toe is psoriatic arthritis. This type of arthritis is autoimmune in nature. Sometimes the first manifestation is psoriasis of the skin, or itchy flaky silvery patches or plaques of skin. People with psoriasis may or may not get psoriatic arthritis, and in fact about 1/3 of patients with psoriasis will see evidence of psoriatic arthritis. The arthritis causes pain and swelling in joints of your foot, and it is usually only one toe at a time and not symmetrical. Since it affects one toe at a time, sometimes it is referred to as "sausage toe" due to the one digit appearing edematous and inflamed. Treatment for this includes controlling the psoriatic arthritis, taking medication to make sure the conditioning is not worsening.
Patients with rheumatoid arthritis, or RA, also have their arthritis manifest conditions in their toes. RA is also an autoimmune in nature, as psoriatic arthritis is. The joints in the foot are lined with synovium, which lubricates the joint and allows easier mobility. RA causes inflammation of this lining, causing swelling in the joints of the feet ant toes. The toes appear swollen and the weakening of the joint may cause deformities, such as a hammer toe or deviation of the digits. Swelling and deformity of the digits can cause areas of increased pressure, so the patient should be aware of this as well. Increased pressure can cause areas of break in the skin which can lead to open sores. To prevent this, our office will recommend a custom made accommodative insert, or a custom orthotic, for the shoe. Our doctors can treat and support some of the manifestations of RA in the foot and toes, however the main treatment is controlling the cause with medications from your primary care doctor or your rheumatologist.
Remember when you see swelling in your toes, it can be many things but one of the conditions may be an arthritis. Arthritis in the toes can be diagnosed by our doctors with a thorough history and radiographs, and we can rule ou an injury, or an infection. But a swollen toe is not normal, and should be examined to get you on the right path to control and recovery.