Understanding Arthritis of the 1st Metatarsophalangeal Joint and Its Treatment Options, an Often Underlooked Pathology

Arthritis is a common condition that affects the bodies joints, including those in the feet. The first metatarsophalangeal joint (1st MPJ), which is also known as the big toe joint, is one of the joints in the feet that can be affected by arthritis. When the joint becomes inflamed, it can cause pain, swelling, and difficulty moving the toe. This can lead to decreased mobility and quality of life. Understanding the different stages of arthritis and the treatments available can help patients make informed decisions about their care.

Hallux Limits vs Hallux Rigidus:

Arthritis of the 1st MPJ is classified into two stages: hallux limits and hallux rigidus. Hallux limits refers to the early stage of arthritis where the joint is stiff, but still able to move through a limited range of motion. In contrast, hallux rigidus refers to the advanced stage of arthritis where the joint is completely stiff and unable to move. Understanding these stages of arthritis can help guide treatment decisions for the patient.

Conservative Treatments:

For patients in the early stages of arthritis, conservative treatments are often recommended to manage pain and reduce inflammation. These may include rest, ice, physical therapy, nonsteroidal anti-inflammatory drugs (NSAIDs), and custom orthotics with carbon fiber bases. In some cases, a cortisone injection may also be recommended. These treatments aim to slow the progression of arthritis and manage symptoms.

Surgical Treatments:

For patients with advanced arthritis who are not responding to conservative treatments, surgical options may be recommended. Two common surgical procedures for treating arthritis of the 1st MPJ are cheilectomy and 1st metatarsophalangeal joint fusion.

Cheilectomy:

Cheilectomy is a surgical procedure that removes bone spurs from the 1st MPJ providing a better contour to the joint. This procedure can relieve pain and improve range of motion in the joint. However, a cheilectomy does not address the underlying cause of arthritis, so the joint may continue to degenerate over time requiring more advanced procedures.

1st Metatarsophalangeal Joint Fusion:

1st metatarsophalangeal joint fusion, also known as 1st MPJ fusion, is a surgical procedure that fuses the bones of the 1st MPJ. This procedure aims to eliminate pain by eliminating movement in the joint. Unlike joint replacement, which involves replacing the joint with a prosthetic, 1st MPJ fusion involves removing the damaged cartilage and fusing the bones together. This procedure has the advantage of being a long-lasting solution for arthritis, but it also eliminates all movement in the joint. Contrary to common belief, this loss of motion does not limit activity in any way. Patients who undergo this procedure generally have great outcomes and retain most if not all of their preoperative mobility.

Arthritis of the 1st MPJ can be a painful and debilitating condition, but there are treatments available to manage it. Understanding the difference between hallux limits and hallux rigidus, as well as the conservative and surgical treatments available, can help patients make informed decisions about their care. Cheilectomy and 1st MPJ fusion are two surgical options that can help manage the pain and disability associated with arthritis of the 1st MPJ. As with any surgical procedure, it is important to carefully consider the risks and benefits and discuss all options with a foot and ankle surgeon.