First Toe (Metatarsophalangeal) Arthritis

What is first toe (metatarsophalangeal) arthritis?

Pain at the base of the first toe, or big toe, is all too common in young adults.  Sometimes patients are told they have a bone spur there, but the real problem is arthritis. When a person walks, their body weight passes through the hip, then the knee, then down to the foot. As they walk through the foot, the body weight goes through the first toe joint - known anatomically as the first metatarsophalangeal (MTP) joint.

What causes it?

From basic physics, we know that pressure is equal to force (body weight) divided by the surface area of the joint. In the hip or knee, where the joints are large, the pressures in those joints are reasonably low. But in the first MTP joint, the area is small, so the pressures end up being quite high. Rather than ask why does someone get first MTP arthritis, the better question is why doesn’t everyone get first MTP arthritis?

How is first toe arthritis treated?

As the joint wears over time, the cartilage thins out.  Bone spurs form on the joint, which limit motion.  Stiffer shoes may be helpful in early stages, and sometimes a rigid insert/orthotic might be beneficial. Anti-inflammatory medications, either pill or injections, can be tried as well.

Ultimately, surgery may be the most powerful way to decrease pain and increase activity. Depending on the degree of arthritis, surgery might be as simple as shaving back the bone spurs. In more advanced cases, a joint fusion is required. The fusion sounds like it might be a problem for an active person, but a patient with a well-healed fusion should have almost no limitations of athletic activities.  For someone dealing with chronic pain in their first toe, a discussion with an orthopedic foot surgeon may be very helpful to determine the cause of the pain and how to treat it effectively.