INJECTION THERAPY FOR OSTEOARTHRITIS OF THE BIG TOE

What is osteoarthritis of the big toe?
The big toe osteoarthritis is a degenerative joint ailment that worsens with age. Males and females are equally affected by osteoarthritis of the big toe, but the majority of patients are over 50 years old. Overuse e.g. distance runners, due to trauma e.g. breaking your big toe, or sustained pressure through the big toe during your working day e.g. wearing high heels can all cause osteoarthritis of the big toe.

Damage to the articular cartilage can occur when the joint surfaces are subjected to increasing stress (which lines the ends of the bones). When this protective layer is damaged, it thins out over time. Synovitis is the term for when a joint becomes inflamed at a later stage. This causes discomfort and stiffness in the toe as a result of the process.

 

What are the symptoms of osteoarthritis of the big toe?

 The following are some of the signs and symptoms of big toe osteoarthritis:
  • The big toe joint has a profound, dull aching. On sometimes, this might be abrupt and sharp.
  • Stiffness, especially after extended periods of rest, such as sleeping.
  • Swelling of the big toe.
  • The uncomfortable side of your big toe may likewise appear larger than the other.

What other conditions can present themselves like osteoarthritis of the big toe?

  • Ankle osteoarthritis
  • Morton’s Neuroma
  • Midfoot osteoarthritis
  • Gout

Osteoarthritis of the big toe vs gout

 Osteoarthritis (OA) of the big toe is a degenerative joint disease that causes pain and stiffness on a daily basis. A gout attack, on the other hand, might strike suddenly and without warning. Gout and osteoarthritis of the big toe can produce pain and stiffness in the big toe. Gout, on the other hand, is associated with redness and heat.
 Gout is a painful illness that most usually affects the big toe. It is brought on by high levels of uric acid in the blood (known as hyperuricemia). Small crystal deposits form inside the joint when hyperuricemia is present. Because movement and touch are excruciatingly painful, walking becomes extremely difficult. Gout is most common in men, patients with kidney failure, and obese people, and it’s also linked to a high-fat diet (red meat and alcohol are common causes of this condition). It can strike anyone at any age, but it is more common in the elderly.
 

What is osteoarthritis?

Osteoarthritis is a degenerative disease that develops within a joint and can be caused by overuse. Often, the specific cause is unknown. This ailment is commonly referred to as ‘joint wear and tear.’ It is a relatively prevalent musculoskeletal disorder, affecting approximately 303 million individuals globally in 2017. (Kloppenburg et el, 2019). Osteoarthritis affects the hips, knees, and big toe on a regular basis. Although osteoarthritis of the big toe is more common among the elderly, it can also affect the younger population. It can be a highly inconvenient and crippling condition.
 Poor foot and lower limb biomechanics, as well as muscular weakness and tension, are all linked to osteoarthritis pain. People with aching large toes, for example, frequently have tight calves. When you walk, this can put too much pressure on your big toe.
 

How do I know if I have an arthritic big toe joint?
The big toe osteoarthritis commonly develops over a long period of time (several months). On occasion, the discomfort can come on unexpectedly if you ‘stub’ your toe or drop something on it. It’s fairly uncommon for pain levels to fluctuate.

It’s not always clear why a joint becomes painful all of a sudden, but it can be linked to an increase in activity, such as hill walking, beginning a new exercise/sport, or wearing new shoes (particularly high heels). If you take a break from the irritating activity for a few weeks and wear sensible lace-up shoes or supportive trainers, these flare-ups will usually go away on their own. If it persists for more than a few months, we recommend that you seek professional help.
Touching or moving an inflammatory osteoarthritic big toe can be unpleasant, and it can typically appear enlarged or ‘puffy.’ It may also be stiffer on one side than the other, and the form of the joint may vary.
The cause of a painful swollen joint is that the joint has gotten inflamed. This is referred to as a’synovitis’ of the joint. When you walk, a synovitic joint can be highly uncomfortable and painful, resulting in a limp. It’s also seen in runners, especially those who run large distances.
Maintaining adequate flexibility and strength surrounding the joint has been shown to help reduce disease progression, but this does not guarantee you a new joint (Hunter et al, 2009).
How is osteoarthritis of the big toe diagnosed?
Your physiotherapist will do a thorough clinical examination of the affected joint as well as the surrounding joints and muscles. This will include a look at joint range of motion, muscle strength, and muscle length, as well as any joint deformities, edoema, or redness.

X-rays are frequently required. An X-ray is used to evaluate the bones, joint surfaces, and joint space. This can be helpful in determining the severity of osteoarthritis. Your doctor can help you with this. Blood tests may also be required. This is to rule out rheumatoid arthritis, gout, or other systemic rheumatological illnesses as a differential diagnosis. To ensure that you receive the most effective treatment, it is critical that you receive a correct diagnosis. If any of these tests are required, your physiotherapist will inform you.
Using ultrasound guidance for the diagnosis of osteoarthritis
Joint Injections has a team of highly skilled physiotherapists who are also trained in the use of diagnostic ultrasound. Ultrasound imaging is used to look for symptoms of osteoarthritis and inflammation. Ultrasound imaging has been proven to be extremely sensitive in detecting early joint changes associated with arthritic joint pain (Wakefield et al, 2000). Gurjit and colleagues (Gurjit et al., 2020). Gout is a reasonably prevalent cause of big toe joint pain, and diagnostic ultrasonography is particularly sensitive in assessing a joint for Gout.

How do we treat osteoarthritis in the big toe?

It’s critical to figure out why the joint has become arthritic. A comprehensive assessment of your hips, knees, and feet is performed at Joint Injections in order to detect any contributing issues. To help promote movement and relieve pain in your big toe, your doctor may recommend manual therapy treatments such joint mobilisations, soft tissue techniques, and acupuncture. You will also be given a personalised set of workouts.

Here are a few additional pointers to consider:
1. Reduce your running or quit wearing high heels to avoid exacerbating symptoms.
2. To relieve pain and inflammation, place a small bag of peas covered in a tea towel over the joint for 10 minutes (be careful not to cause an ice burn)Unless it’s extremely painful, stretch your big toe.
3. Exercises to strengthen your calf muscles – unless they worsen your pain.
4. For your shoe, try using an off-the-shelf inner sole (known as an orthotic)
5. Consult a pharmacist before taking a topical anti-inflammatory such as Voltarol gel.

What if the conservative treatment fails?

If conservative treatment options have failed, there are a few other treatment options that can be very effective in reducing pain and improving function.

  • Injections Using Ultrasound Guidance
    If the discomfort persists and does not go away, a steroid injection may be necessary. Under ultrasound guidance, a mixture of local anaesthetic and corticosteroid (a strong anti-inflammatory) is administered. This ensures that the joint is precisely addressed. Guided injections are more accurate and effective at reducing pain than non-guided injections, according to research.
  • Hyaluronic Acid Injection with Ultrasound Guidance (Ostenil Plus)
    Hyaluronic Acid is a chemical that occurs naturally in the body. A growing amount of evidence supports its use in the treatment of chronic musculoskeletal joint disease including osteoarthritis. This can be injected with the use of a local anaesthetic.

A referral to a podiatrist for a tailored orthotic (a specialised inner sole for your shoes) to offload the sore area and give the joint time to calm down may also be recommended. We may send you to an orthopaedic expert for additional imaging, such as an MRI and/or X-ray, as well as the opportunity to explore surgery options.

Joint Injection’s experts are dual-trained, highly specialised physiotherapists and musculoskeletal sonographers with extensive experience diagnosing all foot and ankle disorders. We provide a ‘one-stop’ clinic, which means you’ll get an examination, a diagnostic ultrasound, and, if necessary, an ultrasound-guided injection.