Wednesday, October 21, 2009

A Different Kind of Bunion

Ever wonder why the big toe joint is so achy? Does it feel stiff, sore, or swollen? Your big toe joint can go through a lot of abuse over years. It gets stubbed, jammed, and squeezed into shoes. All of this microtrauma can lead to long term damage. Who would have thought your big toe could be such a pain.
Hallux is another name for you big toe. Like any joint, your hallux joint consists of two bones with a layer of cartilage on both ends. The cartilage provides for a sleeker surface and absorbs shock to protect the bones from damage. When one suffers from arthritis it is due to a breakdown or damage to the cartilage that causes the bone to run up against bone. This rough friction causes swelling and pain.

Over the years your big toe joint can suffer damage from simple accidents like stubbing your toe in the middle of the right, dropping an object on your toe, and so many other things. Eventually, the cartilage gets damaged and is slowly destroyed. The first symptom of this destruction is limited joint motion. When we walk, our big toe joint should have about 65 degrees of motion. With joint damage, the amount of motion gets smaller and smaller and BAM! The pain hits you out of nowhere! All of a sudden you notice your big toe is stiff or rigid and oh so painful.

Hallux Limitus refers to a decrease in big toe joint motion and Hallux Rigidus is when there is complete loss of big toe joint movement. The early symptoms of hallux limitus consist of pain and stiffness in the joint when walking, standing, and especially squatting. There may be an increase in pain in colder temperatures and damp weather. There is often swelling at the joint. Over time the jamming of bone up against one another can cause new bone formation that forms a bump on the top of your joint. This bump is called a bone spur. This will cause the joint to be more painful and it will eventually lose complete motion or become rigid.

Patients often confuse this disease with a bunion because they both form a bump by the big toe. Though a bunion is also very painful, it is a completely different problem. Bunions are formed when your bones get displaced off to the side. Thus, the bump is on the inside of your foot. With hallux Limitus and Rigidus, the bump is on top.

The treatment for Hallux Limitus/Rigidus depends on how far along the disease has progressed. At early stages, it is important to promote motion at the joint. The more the joint is exercised, the better the outcome will be. This can be customized with orthotics and physical therapy. In cases of a more severe hallux limitus, surgery might be needed to remove the bump or sometimes the joint is replaced with a metallic joint implant. If the disease progresses to Hallux Rigidus, the therapy is surrounded around minimizing joint movement to decrease the pain. This can often be done with orthotics, but in most cases surgery is necessary.

Sometimes, the lack of motion at the big toe joint is asymptomatic. However, the person’s gait is altered and is suffering from knee or lower back pain or even pain on the outside of the foot. When you can’t push off with the big toe joint, you will need to apply more pressure on the outside of that foot. This can lead to pain in other areas of the body.

So, if you are suffering from pain along the big toe joint, do not hesitate to see a podiatrist. In the early stages of these deformities, surgery can possibly be prevented. If you are having back or knee pain, make sure your doctor checks your feet. Remember, if the ground floor is broken, then the other floors will crumble as well.

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