gout big toe
today i'm talking about arthritis of the bigtoe joint. this is also called hallux rigidus. so essentially what this is, it's arthritisof this joint here. so if you look at a normal step what should happen as we walk is thisjoint bends 60 to 80 degrees. you can imagine, if this joint wears out, which is what arthritisis, how painful that can be. so as you walk forward now, you can no longer bend this joint. now let's look over at this picture here.so this is what that joint should look like with that cartilage in that joint a hundredtimes smoother than glass. as it starts to wear out, this cartilage gets thinner andthinner to the point where down here we have hallux rigidus or that there is no cartilageleft and essentially there is no motion left
in this joint, or if there is motion it'sjust a few degrees that leads to pain. so when we look at trying to treat this probleminitially, our goal is to eliminate the pain so that people can walk pain free and do theactivities they want to do. in most cases if it is early on, meaning thereis not bad arthritis, we want to do something to enhance the motion in that joint. in thatsituation we might use either a prefabricated or a customer orthotic to try and bring thisbone down a little bit more because whenwe do that, that helps the motion in this joint.but over time if this joint gets bad enough that it really starts to get quite worn outand there's very little cartilage left, that isn't going to eliminate pain.
in order to eliminate pain we have to do somethingto stop motion and there's several ways to do that. first of all, we still want to useeither a prefabricated or custom orthotic to transfer pressure off of this area andget more pressure back here. custom orthotics tend to work better because they conform closerto the arch but there's also some good over-the-counter devices that can work. actually if you goto our website and do a search for hallux rigidus or big toe arthritis, you'll finda list of over-the-counter devices that might help you. the second thing that we might do is do someshoe changes. you can buy shoes, either athletic shoes or dress shoes or walking shoes thatare rigid on the front. this is called a rocker
sole. you can see i cannot really bend thatsole. so as this person starts to walk forward in this type of shoe, the shoe rocks you throughthe step and the toe joint does not have to move. that can be very effective at eliminatingmotion in that joint and eliminating pain. you could also purchase what's called a turftoe plate. it's a rigid plate that goes inside a shoe in order to stop motion. there's evenwomen's dress shoes on the market that come with platforms, for example. those have rigidsoles on them. so we'd like to do all of this before consideringsurgery. there are surgical options that can also be done. if it gets too bad where yougot real arthritis in that joint, usually you're considering a fusion of that joint.usually it's actually a fairly effective surgery,
most patients do very well, but we alwaysconsider surgery a very last resort. so if you have pain in your big toe joint, don'tlive with it. it can only get worse. often we catch it early enough, we can prevent furtherdamage or at least slow the potential for damage. later on if there is quite a bit ofdamage of the joint, we can still do a lot to eliminate your pain. so if you're in ourarea, make an appointment to see us. if you're not in our area find a podiatrist that specializesin biomechanics and orthotic therapy. they can usually help you a lot.