Bone & Joint
Submitted by Peter Stasko, DPM, Finger Lakes Bone and Joint Center
Dear Doctor:
I have recently had increased pain in my great toe joint. Pain has been present in this general region for quite some time, but now the pain prevents me from performing activities that I like to perform. How do I treat this?
Answer:
Dear Reader:
The pain sounds like it is a chronic problem, now becoming worse. Typically, arthritis presents in this manner. With pain, associated stiffness will occur and eventually the joint motion will almost completely stop. Once the stiffness occurs, cartilage within the joint is being lost and worn away. Eventually, the joint will be bone-on-bone and almost complete motion will be lost. When the joint reaches this point, it is end-stage arthritis. Here are some suggestions and recommendations depending on the degree of pain and arthritis.
Should the joint have some pain and motion is still maintained, a custom orthotic with modifications can help. Injections and anti-inflammatory medications can also be of benefit. These patients are in the phase of the arthritis called hallux limitus. Should these work, the patient continues with this treatment until pain occurs again. Surgical intervention may be of benefit where the joint is maintained and procedures aim at removal of bone and/or osteotomies for creating more joint space. These procedures can even help to prevent the arthritis from getting worse. This is one the reasons it is important to seek early treatment.
Should the joint have pain all of the time or almost all of the time and the motion is limited or non-existent, the use of conservative (nonsurgical) treatment can be performed but may be more limited. Injections and orthotics may be temporary or may not help at all. These patients are in the phase of arthritis known as hallux rigidus. The cartilage has been worn away and the joint may even have a popping/clicking sound where pain occurs with any activity. Individuals may also see changes to the joint size as bone grows and this part of the foot appears larger. There are surgical options for these patients. Removal of bone may help, and even though may only be temporary, can provide adequate relief. More definitive procedures aim at either a fusion of the joint or a joint replacement. A joint fusion takes away from all motion at the joint and at the same time takes away from the pain.
Individuals can still exercise with these procedures with no further procedures needed in the future. Joint replacement procedures can give the patient motion and take away from the pain. Patients are typically in a certain age range for the joints to be replaced and there is usually only a certain amount of years these implants are viable. These can provide a great alternative to a fusion procedure and there have been many advancements in these joint replacements.
I hope that the information provided helps. As always, take care and keep reading.
Peter Stasko, DPM, a fellowship trained Foot and Ankle Surgeon, earned his medical degree at Des Moines University College of Podiatric Medicine and Surgery and completed a three year foot and ankle residency program at the top ranked Western Pennsylvania Hospital Foot and Ankle Surgical Residency in Pittsburgh. He also completed a foot and ankle fellowship at the Mon Valley Foot and Ankle Reconstructive Fellowship in Pittsburgh. Dr. Stasko sees patients at Finger Lakes Bone and Joint in Newark and Geneva and performs surgeries at Newark-Wayne Community Hospital.
