Arthritis is progressive degeneration of cartilage which exposes joint surfaces to rub against each other causing pain. As a protective response new bone in the form of osteophyte forms at joint margin to prevent extra movement. Arthritis can be painful and can eventually lead to loss of joint movement, joint function and deformity of joint with progression of disease.

There are many form of arthritis that can affect great toe. Most common forms are

Osteoarthritis: Degenerative arthritis is commonly associated with aging. Obesity, activity and foot deformity like flat foot and bunion are the other risk factor. In early stage of osteoarthritis the condition is named as hallux rigidus or limitus.

Rheumatoid arthritis: it’s an inflammatory arthritis can involve all the joints of foot with bilateral symmetrical involvement. It causes destruction of joint and produce deformity due to inflammatory response.

Gout: Happens due to deposition of uric acid crystal. Present as acute painful condition with swelling and redness.

Psoriatic arthritis: It is also an inflammatory arthritis happens in psoriatic patients. Commonly affects ankle and toe tip joint.

Post traumatic arthritis: Happens following a fracture or dislocation of ankle and other foot joints. Either due to mal-reduced joint surface, cartilage damage during initial trauma or periarticular deformity causing chronic stress over joints. One may not be symptomatic for several years after the initial trauma.

In osteoarthritis pain, swelling, and stiffness is the initial symptom. Gradually with progression of disease, restriction of movement and deformity develops. Initially symptom is activity related later on it become constant. In inflammatory arthritis pain, swelling and stiffness is not activity related and joint destruction is aggressive than osteoarthritis. Inflammatory signs are more marked in inflammatory and gouty arthritis.

If you are suffering from pain, swelling, stiffness and redness of any area of your foot and ankle you should consult a specialist Foot & Ankle surgeon for evaluation.

After evaluating your symptom and examination of your foot your doctor may advice for weight bearing plain x-ray of foot. Sometimes MRI or CT scan may be required in early cases. A complete blood work is mandatory to rule out any inflammatory condition.

Treatment of arthritis depends on so many factors like type of arthritis, degree of involvement, patients age, activity demand and profession of the patient, presence of associated deformity etc. Considering all the factor treatment need to be individualised for each and every patients. Treatment options may be conservative or operative.

Conservative:

• Lifestyle Modification– minimizing activities which aggravate pain, switching of activity from high impact (running, tennis) to low impact (swimming, cycling), weight loss.
• Physiotherapy-your physiotherapist helps you to gain lost movement as well as strength with the help certain exercises. Physiotherapy also helps you to overcome pain and swelling through various treatment modalities.
• Orthotics-customised orthotics helps in mobility as well as decreases pain by stabilising and restricting painful joints.
• Medication-NSAIDs and over the counter pain relief drugs are helpful in reducing symptom. Ice pack is also a good modalities to relief symptom. In case of inflammatory arthritis DMRDs are required to modify the disease and reduce the symptom as well as disease progression
• Intra-articular injectionof steroid and PRP also helps in symptomatic relief.
• Dietary restriction is recommended in gout. Excess protein content food like red meat, sea food, beans, tomato, spinach, wine and other alcoholic beverages are restricted.

 Surgical

• Open joint debridement and osteophyte excision is satisfactory in early stage of rigidus.
• Osteotomy and deformity correction in flat foot, high arched foot, hallux valgus and post traumatic deformity.
• Arthrodesis or fusion of joint is done in very advanced stage.
• Excision or interposition arthroplasty is a good salvage procedure.