First MTP (Metatarsophalangeal) Joint Arthritis or Pathology of the big toe

The First Metatarsophalangeal joint is located at the base of the big toe. This joint helps with toe-off when walking. This is often the site of a bunion or arthritic changes within the joint. If arthritis is present, there will be damage or degenerative changes to the joint cartilage which can become thin and eventually allow bone on bone contact. This can cause pain, swelling and stiffness of the affected joint. Therefore it is most noticeable when walking or running. Treatment may depend on the severity of symptoms and the clinical presentation. There are a variety of non-surgical and surgical options available to help you return to a more normal, active lifestyle.

  • Video:

    This procedure treats severe arthritis of the joint at the base of the big toe. This is the first metatarsophalangeal joint, commonly called the first “MTP” joint. Arthritis in this joint can cause pain and swelling. It can limit your ability to walk, and it can limit the types of shoes you can wear comfortably. During this procedure, a metal plate is implanted to prevent movement of the MTP joint.

  • Cause:
    • 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
  • Symptoms:
    • May depend on the specific underlying cause.
    • Usually involve pain especially with activity and toe push off.
    • Progressive stiffness.
    • Difficulty walking or walking on the outside of the foot.
    • Swelling.
    • May notice difficulty with shoe wear.
    • May have symptoms on both feet.
  • Natural History:
    Usually gradually gets worse over time. Symptoms may wax and wane.
    If it is due to an inflammatory disease, symptoms will be related to the activity of this disease.
  • Imaging:

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

  • Non Operative Treatment:
    • 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:

    Considered if symptoms are progressing and function is decreasing after a trial on non-surgical treatment. Sometimes these procedures may be combined with other procedures. Depending on the extent and nature of disease, surgical options may include:

    • Joint sparing procedure e.g. cheilectomy and osteotomy
    • Joint replacement procedure
    • Open fusion
    • Occasionally achilles tendon lengthening is also required

    Most patients can lead an active, normal life after a big toe fusion, but the motion at this joint will no longer be there i.e. it will be stiff.

Post-operative Guide – Arthrodesis Post-operative Guide – Arthroplasty Further Reading

General info: