What Is Arthritis in the Big Toe?
Arthritis in the big toe most often refers to osteoarthritis of the first metatarsophalangeal (MTP) joint. This joint, also known as the main joint or joint of the big toe, is clinically important because it connects the big toe to the foot and is essential for walking, running, and balance. Over time, arthritis of the big toe causes the cartilage to wear away, affecting the joint surfaces of the metatarsal phalangeal joint, which leads to pain, swelling, stiffness, and sometimes bone spurs. In many cases, arthritis of the big toe can also result in the formation of a bony lump on the top of the joint, causing pain and difficulty with shoe fitting [1].
When Is Surgery Needed for Big Toe Arthritis?
Surgery is considered when non-surgical treatments (medications, orthotics, physical therapy, steroid injections, shoe modifications, and other treatments) no longer relieve pain and pain or loss of function is severe. Surgery is typically recommended after other treatments, such as steroid injections, have failed to relieve pain. Indications for surgery include:
- Persistent pain that limits walking or daily activities
- Severe stiffness or loss of motion in the big toe
- Failed response to conservative treatments
- Significant bone spurs or joint deformity
The goal of surgery is to relieve pain and restore function.
A thorough assessment by a foot and ankle specialist is essential to determine if surgery is right for you [2]. Your specialist will discuss all surgical options and other treatments before recommending surgery.
Types of Surgery for Arthritis in the Big Toe
- Cheilectomy: Removal of bone spurs, bony bumps, and part of the joint surfaces to improve motion and reduce pain. Best for mild to moderate arthritis.
- Arthrodesis (fusion): Also called big toe fusion, this procedure involves fusing the two bones (the first metatarsal and proximal phalanx) of the big toe joint to eliminate pain. The surgeon removes the damaged joint surfaces and positions the bones in the correct position, securing them with hardware to ensure proper healing and alignment. Best for severe arthritis or deformity. Results in loss of joint motion but high pain relief rates.
- Joint replacement (arthroplasty): Replacing the damaged joint with an artificial implant. The procedure involves removing the arthritic bone and joint surfaces before placing the implant. Used in select cases to preserve motion.
- Osteotomy: Cutting and realigning bones to improve joint mechanics.
Joint fusion (arthrodesis) is a reliable surgical option for severe cases of big toe arthritis, providing permanent pain relief by fusing the bones together.
Some procedures, such as bunion surgery, can be performed using keyhole techniques for less invasive treatment and faster recovery.
The choice of procedure depends on arthritis severity, age, activity level, and personal goals [3].
What to Expect After Big Toe Arthritis Surgery
- Recovery time: Varies by procedure. Cheilectomy: 4–8 weeks; Fusion: 8–12 weeks; Replacement: 6–10 weeks. Wound healing typically takes about two weeks, after which a follow-up appointment is scheduled.
- Rehabilitation: Physical therapy, gradual return to weight-bearing, and use of special shoes or crutches. Keeping the foot elevated helps to reduce swelling after surgery.
- Outcomes: Most patients experience significant pain relief and improved function, but some loss of motion is common after fusion. Some patients may experience pain or discomfort during the initial recovery period. Most people can expect to return to normal activities and start wearing their normal shoes after the recovery period.
- Risks: Infection, blood clots, nerve injury, implant failure, or persistent pain (rare).
The full benefit of the operation is usually achieved several months after surgery.
Alternatives to Surgery for Big Toe Arthritis
- Medications: NSAIDs, pain relievers, and corticosteroid injections for inflammation.
- Physical therapy: Exercises to improve strength, flexibility, and gait.
- Orthotics and supportive footwear: Patients are advised to wear custom insoles, stiff-soled shoes, or rocker-bottom shoes to reduce joint stress.
- Activity modification: Avoiding high-impact activities and choosing supportive shoes.
- Regenerative therapies: Prolotherapy and PRP injections for pain relief and joint healing.
Prolotherapy
In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat arthritis in the big toe.
Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.
Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with arthritis in the big toe.
As prolotherapy is helping to treat the root cause of arthritis in the big toe, it is deemed to be a permanent fix, preventing the symptoms from returning.
Case Study: Walking Again After Big Toe Arthritis Surgery Alternative
Patient: Linda, 67, retired nurse
Condition: Severe osteoarthritis in the big toe, recommended for fusion surgery
Treatment: 3 sessions of prolotherapy at ProHealth Clinic
Outcome: Linda avoided surgery, reported a 75% reduction in pain, and was able to walk for 30 minutes without discomfort at her 6-month follow-up.
Are Big Toe Arthritis Treatments Safe?
Most non-surgical treatments, including prolotherapy and orthotics, are considered safe when performed by experienced clinicians. Surgery is generally safe but carries a small risk of complications such as blood clot formation, including deep vein thrombosis, infection, or implant failure. Although rare, complications can sometimes result in permanent disability. Chronic regional pain syndrome is another rare but serious complication that can occur after foot or ankle surgery. Always consult a qualified practitioner to discuss risks and benefits [4].
How to Choose the Right Treatment for Big Toe Arthritis
The best approach depends on your arthritis type, severity, lifestyle, and treatment goals. A thorough assessment by a specialist is essential. It is important to discuss your general health with your specialist before surgery, as optimizing your overall well-being can improve surgical outcomes and recovery. Smoking cessation is also recommended prior to surgery to enhance healing and reduce the risk of complications. At ProHealth Clinic, we create personalised treatment plans, often combining therapies for optimal results.
Frequently Asked Questions
When is surgery needed for arthritis in the big toe?
Surgery is considered when pain, stiffness, or deformity severely limits daily activities and non-surgical treatments have failed.
What is the recovery time after big toe arthritis surgery?
Recovery varies by procedure: cheilectomy (4–8 weeks), fusion (8–12 weeks), replacement (6–10 weeks). Physical therapy and gradual return to activity are important.
Is prolotherapy safe for big toe arthritis?
Yes, prolotherapy is considered safe when performed by trained professionals. Side effects are rare and usually mild.
Can I avoid surgery for big toe arthritis?
Many patients find relief with non-surgical treatments such as prolotherapy, orthotics, and physical therapy. Surgery is reserved for severe or non-responsive cases.
What shoes are best after big toe arthritis surgery?
Supportive shoes with a wide toe box, stiff sole, and good arch support are recommended. Custom orthotics may help reduce pain and improve mobility.
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Don’t let arthritis in the big toe control your life any longer. Join the thousands of patients who have found lasting relief through prolotherapy at ProHealth Clinic.
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Email: info@prohealthclinic.co.uk
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Author Bio
Having performed over 10,000 procedures, Mr Eaton is one of the UK’s leading practitioners in the field of treating arthritis in the big toe, with patients travelling to see him from across the UK, Europe, and the Middle East.
With over 12 years of clinical experience, Oliver is dedicated to helping patients understand their symptoms associated with arthritis in the big toe and providing effective treatment options to alleviate them.
He qualified in Prolozone Therapy and Prolotherapy in America with the American Academy of Ozonotherapy. He continued on to complete further qualifications at the Royal Society of Medicine, Charing Cross Hospital in London, Keele University’s Anatomy & Surgical Training Centre, and the medical department of Heidelberg University in Germany.
Over the years he has had the privilege of treating many elite-level athletes, including both Olympic and Commonwealth medallists.
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References
- Coughlin MJ, et al. Hallux rigidus: demographics, etiology, and radiographic assessment. Foot Ankle Int. 2003;24(10):731-743. Link
- Thomas JL, et al. The diagnosis and treatment of forefoot arthritis. Foot Ankle Spec. 2011;4(6):329-337. Link
- Kraus VB, et al. Imaging in osteoarthritis. Osteoarthritis Cartilage. 2015;23(8):1287-1299. Link
- Rabago D, et al. Prolotherapy in primary care practice. Prim Care. 2010;37(1):65-80. Link