Big Toe Joint Arthritis Treatment in Los Angeles

What is Big Toe Joint Arthritis?

Big toe joint arthritis, also known as hallux rigidus or hallux limitus, is a degenerative condition affecting the first metatarsophalangeal (MTP) joint. Over time, the cartilage within the joint deteriorates, leading to pain, stiffness, and restricted movement. If left untreated, arthritis can worsen, causing bony growths (spurs), swelling, and joint deformity.

Signs and Symptoms of Big Toe Joint Arthritis

Symptoms can range from mild discomfort to severe pain that interferes with daily activities. Common signs include:

• Pain and stiffness in the big toe joint, especially when walking
• Limited upward movement of the toe, affecting push-off during walking
• Swelling and joint inflammation around the big toe
• Bony growths (spurs) causing pressure and irritation in shoes
• Clicking or grinding sensation (crepitus) with movement

Causes of Big Toe Joint Arthritis

Several factors contribute to big toe arthritis, including:

• Biomechanical imbalances, such as a long or short first metatarsal
• Repetitive stress injuries that are common in athletes and dancers
• Past fractures or joint trauma
• Inflammatory conditions, such as gout or rheumatoid arthritis
• Bunion deformities, which alter joint alignment and function

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How is Big Toe Joint Arthritis Diagnosed?

Dr. Soomekh, regarded as the best podiatrist in Beverly Hills and Los Angeles, conducts a comprehensive examination to assess joint function and pain levels. Diagnosis includes:

1. Clinical Evaluation: Dr. Soomekh will check for tenderness, swelling, and range of motion
2. Gait Analysis: He will also carefully observe how the foot moves during walking
3. Digital X-rays: The team will identify cartilage loss, joint space narrowing, and bone spurs
4. CT Scans (if necessary): Dr. Soomekh will review detailed imaging of the joint for surgical planning

Big Toe Joint Arthritis Treatment in Los Angeles

Dr. Soomekh emphasizes early diagnosis and treatment to slow arthritis progression and prevent long-term complications.

Conservative Treatment for Hallux Rigidus

Joints do not have a significant blood supply. For this reason, it is difficult for joints to repair damage on their own.

Conservative treatments rely on their ability to accommodate big toe arthritis. This can be achieved by wearing appropriate shoes with a wide toe box and stiff soles. A stiff-soled shoe reduces the amount of movement in the joint, leading to less pain with each step. Rocker-bottom shoes will roll the foot forward, leading to less movement of the joint. Reducing the activities that cause pain and damage to the joint can help reduce the painful inflammation and the progressive wear on the joint. Padding over the bone spur bump can take the pressure off the area. Ice and anti-inflammatories can reduce the irritation when there is a flare. Custom molded orthotics can be made as an important tool to slow the progression of the damage to the joint in cases of a biomechanical deformity.

Injection Therapy for Arthritis of the Big Toe

Corticosteroids

Injected steroids are catabolic. This means that they break down tissue. They are used in an effort to reduce inflammation and scar tissue, which are a secondary cause of pain within the arthritic joint. They cannot reverse or heal any damaged cartilage. They are used to bring temporary relief. There is a limit to the number of these injections that are recommended. Dr. Soomekh offers this injection with little discomfort in the office setting under ultrasound guidance for precision. There is no restriction of activity after this type of injection. Most patients’ pain will return over time.

Joint Fluid Replacement (Hyaluronic Acid Injection, Supartz)

Dr. Soomekh offers an injectable material that can lubricate and cushion the joint. This fluid has been shown to help the joint move with less irritation and damage to the cartilage, which can translate to less pain within the joint. Some studies even show mild regeneration of cartilage after these injections. Most patients will need multiple injections over time to achieve relief, and there is no limit to the number of injections. Dr. Soomekh offers this injection with little discomfort in the office setting under ultrasound guidance for precision.

Platelet-Rich Plasma Therapy (PRP)

Platelets are the cells that produce the key healing factors in the body. When there is an injury, platelets rush to the area to begin the healing process. In a chronic injury, there are very few platelets in the area to aid in repair. The introduction of platelets by injection can lead to a higher concentration that may be able to better aid in the healing process. In the office setting, a small amount of blood is taken from the patient. The blood is spun in a centrifuge to filter the platelets from the other blood products and obtain the PRP. The PRP is then injected into the big toe joint. Dr. Soomekh performs this injection with little discomfort under ultrasound guidance for precision.

Surgical Treatment for Hallux Rigidus

Dr. Soomekh will always recommend and attempt conservative treatment when appropriate. However, when hallux limitus becomes painful, daily activities become a struggle, and conservative treatments have failed, surgical repair may be indicated.

Considering surgery can be intimidating. Foot surgery, including surgery to correct hallux limitus, is not supposed to be painful during recovery. When the skin and the soft tissues are handled with care and focus, most patients experience little to no pain immediately after surgery and throughout the recovery period. Dr. Soomekh takes great care and focus to minimize the chance of postoperative pain. The goal of surgery to correct hallux limitus is to remove any extra bone, clean out the joint, promote new cartilage growth when possible, alleviate pain, allow a return to normal shoes, and allow a return to activities. Most procedures allow for immediate walking and a return to work while wearing a special walking boot. Dr. Soomekh performs the procedures in an outpatient setting at our state-of-the-art facility.

There are many different procedures and techniques for treating hallux limitus. The surgeon is responsible for investigating each specific aspect of the deformity for each individual patient in order to formulate the proper procedure for repair. Dr. Soomekh will use the information gained from the patient’s symptoms, age, activity level, lifestyle goals, the severity of the deformity, the clinical examination, the patient’s gait, and the x-rays to make a recommendation on the proper procedure.

Mild to Moderate Big Toe Arthritis

Cheilectomy (Cleaning Out The Joint)

The purpose of this procedure is to extend the functional life of the joint before it becomes even more arthritic. The earlier in the disease process that this procedure is performed, the more rewarding it will be for the patient. A small incision is made on the side of the big toe joint. Any extra bone around the joint is removed. Any floating pieces of cartilage or bone are removed. A precision cut is made at the head of the first metatarsal to remove even more bone to allow for the big toe to move over the joint more easily. Any areas of missing cartilage are stimulated to promote new growth of cartilage. Dr. Soomekh will then close the skin using plastic surgery techniques. The patient is able to bear weight in an assistive boot immediately for two to three weeks, then move into an athletic shoe. The patient will begin immediate range-of-motion exercises.

In some cases, Dr. Soomekh may offer the placement of a regenerative human umbilical cord graft material (Amniox) to lessen scar tissue within the joint. This will allow for an increased range of motion in the long run. The addition of Bone Marrow Aspirate (BMA) may be offered to promote new cartilage formation.

Moderate to Severe Big Toe Arthritis

Decompression Osteotomy

The purpose of this procedure is to relieve joint pressure and clean out the joint while also shortening the first metatarsal to allow more room in the joint for the big toe to move on the long bone. An incision is made on the side of the big toe joint. Any extra bone around the joint is removed. Any floating pieces of cartilage or bone are removed. A precision cut is made at the head of the first metatarsal (osteotomy), removing a section of bone. This head is now allowed to shorten the gap created in the bone cut, giving more room to the joint. This bone is then stabilized with one or two small screws. The screws hold the bone in its new corrected position while the bone heals. Once the bone heals, the screws are not needed and are generally not removed. Any areas of missing cartilage are stimulated to promote new growth of cartilage. Dr. Soomekh will then close the skin using plastic surgery techniques.

Cartilage Grafting With Stem Cell Therapy

The purpose of this procedure is to replace large areas of missing cartilage with new cartilage growth. It is usually performed in addition to the previously mentioned procedures. Stem cells are special cells that have not decided (differentiated) what type of tissue they will become. When these stem cells are placed near cartilage, they become cartilage. Stem cells can be found within the bone marrow. The area of missing cartilage is prepared and stimulated. Bone Marrow Aspirate (BMA) is obtained from the patient’s own heel bone. The stem cells are obtained from the BMA. The donated human cartilage graft, Denovo®, is then mixed with the BMA. The cartilage graft is then placed upon the defect of the joint. Over time, the patient will incorporate the new cartilage graft and use it as a scaffold to build new cartilage.

Big Toe Joint Replacement with Arthrosurface Implant

In severe cases of arthritis, where one part of the joint may still be viable, some may be candidates for a joint replacement. The purpose of this procedure is to replace the missing cartilage and bone with a new metal joint. This will allow for pain-free motion of the joint. Dr. Soomekh uses the most advanced implants available. An incision is made on the side of the big toe joint. Any extra bone around the joint is removed. The surface of one side of the joint (the more damaged side) is prepared by removing all the remaining cartilage and some bone. A special-sized hemi-implant is placed and anchored into the bone. Dr. Soomekh will then close the skin using plastic surgery techniques. The patient is able to bear weight in an assistive boot immediately for two to three weeks, then move into an athletic shoe. The patient will begin an immediate range of motion exercise.

Big Toe Joint Fusion (Arthrodesis)

The purpose of a fusion of the big toe joint is to remove the joint and prevent all movement. No movement = No pain. This procedure joins the big toe bone (phalanx) and the first metatarsal into one bone. The fusion of this joint still allows for normal walking and some activity. An incision is made on the side of the big toe joint. Any extra bone around the joint is removed. The surfaces of each bone are prepared by removing all the remaining cartilage. The two bones are brought together, and two small screws are placed across the joint. The screws hold the bone in its new corrected position while the bone heals into one. Once the bone heals, the screws are not needed and are generally not removed. In some cases, a plate may also be used to hold the bones together. Dr. Soomekh will then close the skin using plastic surgery techniques.

In some cases, Dr. Soomekh may offer the patient the addition of bone marrow aspirate (BMA) with platelet-rich plasma (PRP) to facilitate the fusion. Stem cells are special cells that have not decided (differentiated) what type of tissue they will become. When these stem cells are placed near bone, they become bone. Stem cells can be found within the bone marrow. BMA is obtained from the patient’s own heel bone. The stem cells are obtained from the BMA and mixed with PRP (the healing factors). The material is then placed into the space between the bones.

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