Big toe arthritis treatment

by Nathan Wei, MD, FACP, FACR

Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.

Click here: Second Opinion Arthritis Treatment Kit

Arthritis affecting the great toe is commonly known as "big toe arthritis." What can be done about big toe arthritis pain?

Before you can talk about treatment, you need to talk about diagnosis. So what are the diseases that can cause problems in the big toe?

The list is actually longer than you think.

The most common one is osteoarthritis which leads to the condition known as a bunion. A bunion is a deformity where the base of the big toe starts to turn to the outside. This is caused by the development of osteoarthritis of the first metatarsalphalangeal joint accompanied by bursitis. Proper fitting shoes, padding, and anti inflammatory medicines usually help. In rare instances, surgery is required.

Gout is another common one that affects the great toe. In gout, the first metatarsal phalangeal joint- the joint that joins the toe to the foot – will be swollen, red, and extremely painful.

Typically, the attack will come on in the middle of the night and awaken the patient from sleep. This condition is referred to as podagra. It is caused by deposits of uric acid crystals. The treatment is oral medication although sometimes steroid injection is required.

Another disease that can cause podagra is pseudogout –“ false” gout- caused by a different type of crystal called calcium pyrophosphate. This is usually treated with steroid injection and anti inflammatory medication.

Other diseases such as psoriatic arthritis, reactive arthritis, and ankylosing spondylitis may also affect the great toe and lead to what is called the “sausage toe.”

Treatment for these conditions is to institute better control of the arthritis in general with oral medication and if necessary, biologic therapy.

Tendinitis may also develop in the big toe. Some athletes who play on artificial turf get “turf toe.” This is a very painful problem and requires rest and anti inflammatory medication. Nowadays, platelet-rich plasma (PRP), a derivative of a patient's own blood which contains a large number of platelets, cells that help with the healing process, is the treatment of choice for most forms of tendon issues. It is injected using ultrasound guidance.

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