First MTP Joint Arthritis

1st MTP joint arthritis causes pain, swelling and stiffness that is most noticeable when walking or running. It may affect both feet.

• Pain especially with activity and toe push off
• Progressive stiffness
• Difficulty walking or walking on the outside of the foot
• Swelling
• Difficulty with shoe wear

• Primary osteoarthritis with articular cartilage damage = Hallux Rigidus
• Secondary osteoarthritis: related to trauma or previous fracture/dislocations, or abnormal joint position as in Hallux Valgus (bunions)
• Inflammatory arthropathy, most commonly rheumatoid arthritis
• Gout

• Weight-bearing X-rays are required with additional views
• Occasionally CT scans are required

• Topical pain creams e.g. NSAIDS
• Pain medications e.g. NSAIDS such as Mobic or Panadol Osteo
• Shoe wear modification
  • stiffer soled shoe with rocker bottom modification
  • Morton’s extension to place inside the shoe
  • carbon fibre extender with cutouts for the lesser toes
• Activity modification:
  • improve fitness and strength via non axial loading exercises e.g. cycling, swimming
  • avoid axial loading exercises e.g. running
• Physiotherapy:
  • Achilles tendon stretches
  • hamstring stretches
• Weight loss management
• Joint injections may help with pain management

Surgery is considered in the later stages of charcot foot when there is significant pain and deformity.

• Exostectomy
  Removing bony prominences that are interfering with proper weight distribution

• Achilles tendon lengthening
  Releasing the tension on the tendon to reduce the stress on the bones of the foot

• Fusion surgery
  Using screws and plates to connect the bones that are causing pain during movement by stopping them from moving

All surgery has risks involved, however every effort is made to reduce these risks. Risks include but are not limited to:

• Infection: superficial wounds or deep infections
• Clots: DVT (deep venous thrombosis) or PE (pulmonary embolus)
• Nerve damage: tingling, numbness or burning
• Ongoing pain
• Stiffness of the ankle or MTP joint
• General or anaesthetic risks including to the heart and lung
• Drug reactions/allergy
• Scarring or tethering of the skin
• Nonunion (bones do not fuse adequately)
• Calf weakness
• Revision surgery

There are increased risks of surgery in diabetics, smokers, significant peripheral vascular disease, severe neuropathy, previous or current infection which may preclude a patient from surgery.

View FootForward for Diabetes (run by Diabetes Australia) for more information on foot care.