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Big Toe Problems (Pathology)

Bunion Deformity

A bunion (a.k.a Hallux Valgus) is a common foot condition associated with a prominent bump on the inside of the forefoot (see Figure 1). The word bunion comes from the Greek root for the word turnip. Bunions can lead to discomfort over the prominence, especially if patients wear tight fitting shoes. It is common for bunions to run in family and gradually increase over time. The vast majority of bunions can be managed successfully with basic non-operative treatment. Surgery is reserved for patients who have persistent symptoms in spite of appropriate non-operative treatment.

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Stiff Big Toe Joint (Hallux Rigidus)

Hallux rigidus is essentially a progressive arthritis leading to stiffness and pain in the big toe joints. The loss of cartilage, which occurs first along the top half of this joint, is believed to be the result of repetitive jamming as the big toe joint attempts to move upward with each step. This can take many years to develop, but can become quite symptomatic. In the later stages of this disease process, cartilage covering the remainder of the joint surface also erodes, leading to a progressively worse and more bothersome arthritic joint.

Hallux Varus

Hallux varus is a condition affecting the big toe. As opposed to a bunion, which causes the big toe to point inward toward the other toes, hallux varus causes the big toe to point away from the other toes.

The most common symptom other than the directional leaning of the toe is pain. The discomfort is primarily a result of friction from rubbing against the shoes worn, which may cause blisters to form. If there is also pressure on the toenail from a shoe, the hallux varus may be accompanied by an ingrown nail as well. In rare instances, the joint is extremely unstable and may cause the big toe to dislocate.

Hallux varus may result from a congenital deformity, a short or tight tendon or trauma to the big toe. However, the most frequent cause is bunion surgery that overcorrects the problem.

To diagnose a hallux varus, your doctor will take a medical history as well as perform a thorough examination of your foot. This usually provides enough information for your doctor to determine what has caused the hallux varus to develop.

The treatment of hallux varus varies depending on exactly why it formed. In the case of a tight tendon, a combination of stretching exercises, splinting and corrective shoes is often successful. If these conservative methods do not provide relief, surgery may be required on the soft tissues and/or the bones to straighten the toe. Surgery may also be necessary when the hallux varus has developed due to a bunionectomy.

Sesamoid Pathology

Pain in the ball of the foot below the big toe may be caused by sesamoiditis, an inflammation of two small bones called sesamoids. Sesamoids are found in many joints in the body. In the big toe, they protect the tendons that pull the toe against the ground and stabilize it when you walk. Naturally these two small bones are subjected to great pressure and frequently suffer damage in the form of swelling (inflammation) or stress fractures, especially from high-impact activities such as running, jumping and ballet dancing and from wearing high-heeled shoes. People with very arched feet are also susceptible to sesamoid injury.

Rest, ice, anti-inflammatory drugs and physical therapy are usually enough to reduce swelling and relieve pain. If symptoms persist, cortisone injections are attempted. Long-term treatment aims to prevent recurrence and may involve use of cushioned footwear or orthotic inserts in the shoes. If the bone is fractured, it may be necessary to wear a cast for 6-8 weeks followed by a brace. Surgical removal of the sesamoid is an option for resistant cases.

Turf Toe

A turf toe is an injury to the great toe joint. It occurs when the great toe is forced upward such as may occur when an athlete cuts hard on artificial turf. With too much upward force on the great toe the soft-tissues (capsule) lining the base of the great toe joint is injured or in some instances completely torn. This leads to pain and swelling in the toe. Treatment for partial tears of the capsule includes rest, ice, avoiding aggravating activities, taping or shoes to limit movement of the great toe, and most of all time – often 2-8 weeks or more. Complete ruptures of the capsule require surgery and a prolonged recovery of 4-6 months.

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