Symptoms And Treatments For Osteoarthritis Of The Big Toe

Osteoarthritis is a form of degenerative arthritis that causes pain and swelling in joints. Due to the wear and tear of cartilage in the joint, the bones become more prominent and as a result, rub against each other as they move. While the condition occurs gradually, it worsens over time if left untreated. The big toe is a common area to be affected by osteoarthritis.

Causes

Most cases of osteoarthritis come with age, starting from ages 30 to 60. As the body system slows down, the cartilage deteriorates faster than it can heal, resulting in osteoarthritis to develop.

Obesity also increases the risk of developing the condition. With additional pressure from the body weight, the bones of the feet are stressed and may accelerate the damage of cartilage in the big toe.

Some people are born with an overgrowth of the big toe bone, making the toe joint stiff and difficult to bend, thus more susceptible to developing osteoarthritis.

Symptoms

Some of the first signs of osteoarthritis of the big toe include stiffness, achiness, tenderness and pain in the affected toe, though may also be felt in the arch of the foot and other toes. The toe feels most achy and stiff in the morning and after sitting for a long period of time.

Gradually, you would start to notice swelling around the joint. It might be some time before the bone spur becomes visibly noticeable. However, you would feel the bones rubbing together and causing the area to swell as they get more prominent.

As the big toe gets stiffer, it gets harder to bend the toes. Walking and balancing becomes difficult and painful. The constant rubbing between the toes can cause corns and calluses to form, and even leading to other conditions such as hammer toes.

Treatment

Conservative treatment for osteoarthritis may not cure the condition but can relief the symptoms. Your doctor might prescribe painkillers and anti-inflammatory medicine to ease the pain and bring down the swelling. There are also creams and gels to reduce the swelling. Orthoses can be inserted in your shoes to decrease the pressure while walking. It is best to avoid high heels and pointy-toed shoes as these shoes give puts stress on the feet and may aggravate the symptoms.

For very severe cases, your doctor might recommend a joint replacement surgery. The damaged cartilage is removed and the joint is held together in a fixed and immovable position so that the cartilage would not be affected again. However, the results of the surgery might cause a reduction in mobility. Thus, this procedure may only be suitable for elderly patients that do not require as much mobility in daily activities.

Accessory Navicular Syndrome: Diagnosis & Treatments

Accessory Navicular

Also called the os tibiale externum or os navicularum, accessory navicular is an ossicle, or extra bone, that develops on the inside of the foot, above the arch. It is connected to the posterior tibial tendon and could be fused with the navicular or just a small distance away. As such, it appears to be an extension or an “accessory” of the navicular.

Accessory Navicular Syndrome

If the accessory navicular does not cause any symptoms, the condition might go unnoticed. However, when there is pain involved, it is called the accessory navicular syndrome. This can be triggered by an injury to the foot, such as an ankle sprain, which affects the bone or the posterior tibial tendon. Also an overuse injury, the syndrome could be due to excessive activity, especially when wearing inappropriate footwear that causes constant rubbing against the jutted bone.

Symptoms

More commonly, the first signs of symptoms appear during adolescence, when cartilage is developing into bone. For some, the symptoms only appear in their adulthood, usually after a foot injury of some kind. When this happens, the person would feel pain, redness and swelling on the inside of the foot, above the arch, especially during and after engaging in activity.

Diagnosis

The doctor would first examine the foot for swelling, pressing on the bony prominence to access the pain. The way the patient walks would be observed to evaluate the joint motion and muscle strength. It is important to let the doctor know about any previous foot injuries and when the first signs of symptoms appeared. To confirm the diagnosis, an X-ray or MRI may be ordered.

Treatment

Non-Surgical Treatment:

Usually, the first course of treatment to relieve the symptoms would be non-surgical. Even if surgery is needed, conservative treatment would precede the operation for 4-6 months. These are the methods used:

  • RICE (Rest, Ice, Compression, Elevation) – To reduce swelling.
  • Immobilization – A cast or boot would prevent weight bearing, allowing the foot to heal.
  • Orthotic Devices – Custom orthoses provide support for the foot and prevent aggravation.
  • Medication – Oral medications may be prescribed to reduce pain and inflammation.
  • Physical Therapy – Exercises and treatments such as Ultrasound and electrical stimulation help to reduce inflammation and strengthen the muscles.


Surgical Treatment:

Depending on the symptoms and condition, the surgery opted for may be the simple excision or the Kidner procedure.

  • Simple excision – The accessory navicular is removed along with the bone so that there is no more bony prominence and the symptoms can be relieved. The ligament is then reattached to the navicular.
  • Kidner procedure – Similar to the simple excision, the bony prominence is removed in the Kidner procedure. Additionally, the posterior tibial tendon is split and relocated to the navicular.

Flexible Flatfoot: Symptoms & Treatments

Flexible flatfoot is a progressive condition that typically occurs in children and adolescents. The arch of the affected foot is visible when sitting but collapses when standing. One of the most common types of flatfoot, people with this condition usually bring it into their adulthood as the symptoms may not surface or bother them until much later, when the tendon has deteriorated over the years.

Causes

Patients with some preexisting conditions are at higher risk of getting flexible flatfoot. Diabetes, rheumatoid arthritis and obesity put stress on the tendon that supports the arch, causing it to stretch or tear over time and eventually collapse under pressure.

Other factors like old age, injury to the foot, bunion, hammertoe and short Achilles tendon can also lead to flexible flatfoot.

Symptoms

The first signs of flexible flatfoot are pain and swelling along the inside of the ankle. As the condition worsens, the front of the foot and toes would turn outward and the heel rolled inward. If treatment is further delayed, the pain would shift to the outside of the ankle with the risk of developing arthritis. Patients are also likely to complain about pain along the shinbone, lower back and knee.

Diagnosis

The doctor would first look out for the collapsing and returning of the arch when you stand and sit. Your feet are observed from the front and back to see how much the forefoot has turned outward. An X-ray, CT scan, ultrasound or MRI may be ordered depending on whether details on soft or hard tissue are required.

Treatments

Non-Surgical Treatment:

Treatment would only be necessary when the symptoms have surfaced. Usually, non-surgical treatments are sufficient to relieve the symptoms. Methods may include the following:

  • Rest

Reduce or stop activities that aggravate the pain. Rest your feet more often and avoid standing and walking for too long.

  • Immobilization

A boot or cast helps to prevent weight bearing to allow the tendon to heal.

  • Orthotics

Orthotics are shoe inserts that can be customized to give support to the arch.

  • Losing Weight

If obesity is the cause of the condition, weight loss would help to relieve the pressure and pain.

  • Physical Therapy

Doing exercises stretch the Achilles tendon and provide stability to the joint.

  • Medication

Medication may be prescribed to reduce pain and inflammation.


Surgical Treatment:

If non-surgical treatment does not relieve the symptoms or if there are other problems such as a tendon tear or rupture, surgery would be required. Depending on the injury and severity, these methods might be considered:

  • Tendon Transfer
  • Foot Lift
  • Joint Spacer
  • Bone Fusion or Realignment

Posterior Tibial Tendon Dysfunction (PTTD): Cause, Symptom & Treatment

Posterior Tibial Tendon Dysfunction (PTTD) is a common type of flatfoot that occurs in adults, also often called the Adult Acquired Flatfoot. One of the main supporting structures of the foot, the posterior tibial tendon holds up the foot arch and assists in the walking movement. When the tendon gets torn or inflamed, the foot loses stability and support and the arch collapses, resulting in a flatfoot.

Causes

PTTD is an acute injury caused by a fall or traffic accident. It could also be an overuse injury usually caused by activities that involve intense usage of the tendon, such as running, hiking and soccer. The repetitive impact causes inflammation and tearing of the posterior tibial tendon over time.

Symptoms

Different symptoms develop as the severity of the condition increases. At the first stage, there would be pain, swelling and redness on the inside of the foot and ankle. When the arch begins to flatten, the forefoot and toes start to turn outward while the ankle leans inward with the same inner foot pain.

As the tendon further deteriorates, the arch gets even flatter. By then, the pain has shifted to the bottom outer side of the foot. There is a high risk of developing arthritis in the ankle in such severe cases.


Treatments

Non-Surgical Treatment:

As PTTD is a progressive condition, the earlier treatment starts, the better the chances to avoid surgery. In most cases, non-surgical treatment suffices to relieve the symptoms and keeps the condition from progressing further. Treatment may include the following methods.

  • Rest and Ice

Reducing or stopping activities that aggravate the pain. Then ice 3-4 times a day every 20 minutes to bring down the swell.

  • Immobilization

A cast or boot is worn for 6 to 8 weeks to avoid weight bearing and allow the tendon to heal.

  • Orthotics

Orthotics and braces help to position and support the foot.

  • Physical Therapy

Ultrasound therapy is used to reduce the inflammation while exercises help to reduce the stiffness of the muscles and regain stability.

  • Medication

Medication may be prescribed to reduce pain and inflammation. However, medication alone does not fully heal the injury.

 

Surgical Treatment:

If the symptoms do not improve after 6 months of conservative treatment, surgery would be required. Depending on the severity of damage, different types of surgery are used.

  • Lengthening of Achilles tendon
  • Cleaning the posterior tibial tendon of inflamed tissue
  • Tendon transfer
  • Cutting and shifting bones to support the arch
  • Fusion of bones to remove the joint

Fractures Of The Fifth Metatarsal

The fifth metatarsal is the long bone in the middle of the foot that connects to the little toe joint. Fractures in the fifth metatarsal are common and often occur at the base of the bone.

Types of Fractures

Avulsion Fracture:

There are two main types of fractures in the fifth metatarsal. The more common type is the avulsion fracture. This happens when the tissue of the base of the bone is suddenly pulled away, causing a piece of the bone to be chipped off. It is usually an injury caused by an explosive impact from jumping or a severe sprain of the ankle. Tennis players often incur this injury because of the nature of the sport that constantly requires changing directions. Thus, it is sometimes referred to as a “tennis fracture”.

Jones Fracture:

Jones fracture is a hairline break at the base of the fifth metatarsal, slightly above the area of avulsion fracture. It is an overuse injury caused by repeated stress, but could also be caused by a sudden trauma. This injury is less common and because the part of the bone receives lesser blood, it is more difficult to heal. Recovery often takes longer than two months and chances of non-union are high.

Other types of fractures include stress fracture in the mid-shaft, metatarsal head and neck. These injuries usually occur in athletes as a result of twisting or trauma.


Symptoms

Both avulsion and Jones fractures have the same symptoms. Patients would experience pain, swelling and tenderness on the outside of the foot. Bruises may appear with the bleeding of the broken bones. It would be difficult to walk or bear weight on the foot and not recommended to do so as exertion might cause a further break in the bone.

 

Treatment

Treatment should start as soon as the condition is diagnosed. For most cases, conservation method is used for treating fractures in the fifth metatarsal. However, because Jones fracture has a higher risk of non-union and refracture after it is healed, surgery might be a better option.

Non-Surgical Treatment:

The RICE method (Rest, Ice, Compression, Elevation) should be immediately applied until you receive medical attention. When you get to the doctor’s, the foot is immobilized in a cast or boot with crutches to hold the weight off. Bone stimulation may be used to treat Jones fractures to speed up the healing process.

Surgical Treatment:

There are a few cases when surgery is required – the bone is significantly displaced or incurred multiple breaks, or when non-union occurs with conservative treatment. Internal fixation or bone grafting may be needed to surgically piece the bones back together.

What Is Hallux Rigidus: Cause, Symptom & Treatment

Hallux rigidus is a stiff big toe that occurs when there is an overgrowth at the base of the big toe. It prevents the toe from bending, causing pain and difficulty in walking and standing. This is a disorder of the joint and a form of degenerative arthritis that usually develops between the ages of 30 and 60.

Causes

This condition could be inherited from parents, bearing an abnormal foot structure at birth that is more prone to developing hallux rigidus. It could also be an overuse injury – athletes or people who are constantly engaged in activities that add stress on the big toe, such as squatting and standing, are at higher risk.

Other causes include injury to the toe that damages the articular cartilage, causing the ends of the bones to rub together, and inflammatory diseases such as rheumatoid arthritis or gout.

Symptoms

Some of the symptoms you should look out for are pain and stiffness during walking, standing or even at rest, and the pain worsens in cold weather. Bending of the big toe is very difficult or impossible. There might be swelling around the big toe joint and a bump on the top of the foot. Patients might compensate the inability to use their big toes when walking by using the strength of the hip, knee or lower back, causing pain in those areas. This might lead to walking with a limp over time.

Treatment

Patients should seek medical help once the first signs of symptoms appear as the longer it is delayed, the more difficult it is to treat. If the condition is diagnosed early, non-surgical treatment may suffice for treatment. But if diagnosis is delayed or if the condition is severe, surgery is unavoidable.

Non-Surgical Treatment:

To first reduce the pain and inflammation, oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed. For progressive recovery, patients have to wear shoes with rocker-bottom soles and a large toe box to reduce pressure on the big toe. Orthotic devices are used to support the foot, so that the toe does not have to bend when walking. Physical therapy is recommended for reducing inflammation and improving foot function with exercises.

Surgical Treatment:

If the symptoms do not improve with non-surgical treatment, patient would have to go through surgery. One method is to remove the bone spurs and some part of the bone to make space for the joint to bend. For more severe cases, the bones are fused together, making the joint unable to bend permanently but relieving the pain.

Joint replacement surgery helps to both relieve the pain and preserve joint motion but is usually only recommended for elderly patients that do not have much physical demands.

What Is Equinus? Diagnosis & Treatment

Equinus occurs when the Archilles tendon or calf muscles are too tight to allow upward bending motion of the ankle. The person would find it very difficult or impossible to bring the foot toward the shin.

Symptoms

People with equinus deformity often overcompensate this limitation of motion with the other foot, leg, back, hip or knee, causing problems in those areas. To ease movements, many of them flatten the arch of the foot when walking, placing their body weight on the ball of the foot or toes instead and causing pain and callusing. Others use the support of their hips or knees, resulting in an unusual walking stance.

Causes

The tightness in the Archilles tendon or calf muscles may be inherited from parents or the person is born with shorter Archilles tendon. Having a cast on for a long period of time or wearing inappropriate footwear such as heels, could also cause the stiffness. If the foot suffered a serious ankle injury before, there could be a broken bone blocking the joint, thereby restricting motion.

This deformity could also be a symptom of a more serious condition. Diabetes causes many foot problems, including tightening of the Archilles tendon. If spasms are felt in the calf, it could be a sign of a neuromuscular disease.

Diagnosis

To find out the cause of equinus, the doctor would move the ankle when the knee is bent and straightened to assess if the tightness is from a tendon, muscle or bone block. X-ray may be used for further evaluation. If a neurologic disorder is suspected, the patient is referred to a specialist.

Treatment

The cause of the condition is most important in determining the course of treatment, which could be surgical or non-surgical.

Non-Surgical Treatment:

To relieve the symptoms of equinus, the patient might have to use heel lifts and/or custom orthotic devices in their shoes for better support, weight distribution and reduce pressure in the Archilles tendon. If the stiffness is from the calf muscles, a night splint is used to hold the foot in place during sleep. Physical therapy may be recommended to exercise the muscles and reduce tightness.

Surgical Treatment:

Surgery is opted for when the patient does not show significant improvement with non-surgical treatment or when the condition is too severe. The Archilles tendon can be surgically lengthened to reduce the tightness and gastroc recession is used to correct a portion of muscle. If the problem is a bone block, the fragment of broken bone impeding the joint motion is surgically removed.

Tarsal Coalition: Diagnosis & Treatment

Tarsal coalition is a congenital condition that occurs when the tarsal bones at the back of the foot are abnormally connected, causing pain and limitations in walking. Because of the joint bones, the foot may appear to be made up of a “bar of bones”, looking flatter and stiffer than a normal foot. Depending on the degree of attachment, if the bones are connected by fibrous tissue, the foot would be more flexible compared to a bony connection. About 1% of the population is affected by tarsal coalition.

Causes

Most cases are present at birth as the tarsal bones fail to separate during foetal development. And because tarsal coalition is an autosomal dominant genetic condition, children are likely to inherit the disorder if one of the parents has it.

Symptoms

The symptoms may only appear later in life or when the bones are beginning to mature. The most common sign is pain on the outside of the foot along the fibula, especially when walking or standing. The foot feels stiffer and flatter, and the patient might walk with a limp because of the rigid bone structure. Over time, other joints may be affected and pain is felt at the outer top side of the foot.

Diagnosis

Because the bones are still developing during childhood, it may be difficult to diagnose until the bones begin to mature at about 9 years old. Some people only discover it during adulthood when affected by the symptoms. To help the doctor diagnose, it is important to give a full history of the duration and development of the symptoms, together with the activity level involved in the patient’s daily life. The patient’s walking movements are observed and followed by a thorough physical examination of the foot to look for tenderness and restriction of motions in the joints.

Treatment

Depending on the severity of the condition, surgical or non-surgical treatment can be used to relieve the symptoms and reduce motion of the joints.

Non-Surgical Treatment:

The foot is immobilized in a cast or brace for two to four weeks to allow the joints to rest. Steroid injections and oral medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to reduce the pain and inflammation. After the cast is removed, custom made orthotics is placed into footwear to support the joints and reduce pain when walking. Patient may have to go through regular physical therapy sessions.

Surgical Treatment:

If the patient does not respond well to non-surgical treatment and the symptoms do not seem to subside, or if the condition is too severe, surgical treatment is opted for.

Depending on the age of the patient that tells the maturity of the bones, the goal of the surgery is either to restore the motion of the joints by removing or excising the bones, or fusing the joints together to form a solid bone. Removing or excising the bones is only recommended for young children as restoring motion in more mature and degenerative bones may not be enough to stop the pain.

What Is Haglund’s Deformity?: Cause, Symptom & Treatment

If you notice that the boney section of your heel near the Achilles tendon is prominently enlarged, you probably have Haglund’s deformity. Because of the frequent pressure on the back of the heels due to inappropriate footwear or because of the natural shape of the foot, bursitis – an inflammation of the fluid-filled sac between the tendon and the bone – progressively develops.

Causes

Haglund’s deformity can happen to anyone. Also known as “pump bump”, the name derives from women that get this condition because of the rigid back of their pumps, though it can also occur in men who wear stiff dress shoes. Inherited foot structure is another cause. If you have a high arch, a tight Archilles tendon or tend to walk on the outer edge of your foot because of its shape, you would be more likely to develop this deformity. Seasoned ice skaters are also at risk because of the long hours practicing in rigid skates.

Symptoms and Diagnosis

Depending on the cause of the problem, Haglund’s deformity may occur in one or both feet. You would notice a bump on the back of the heel, along with severe pain and swelling. Because the soft tissue is inflamed, redness may be visible.

Diagnosis may be difficult because of the similar symptoms to arthritis. However, doing an X-ray to evaluate the structure of the heel could help determine the condition.

Treatment

Non-surgical and surgical treatment methods are used to relieve the pain and pressure from the heel bone depending on the severity of the deformity. Often, non-surgical treatment is initially tried out to see if the condition improves.

Non-Surgical Treatment

One or more of these methods may be used:

  • Icing for 20 minutes every 40 minutes a day to reduce swelling of the inflamed area.
  • Stretching exercises to reduce tension of the Achilles tendon.
  • Shoe modification using heel pads, heel lifts, arch supports or wearing open-heel shoes to minimize pressure on the heel.
  • Using custom orthotic devices to correct the position of the foot.
  • Physical therapy like ultrasound treatment and iontophoresis to reduce inflammation
  • Immobilization in a cast or brace.
  • Taking non-steroidal anti-inflammatory drugs (NSAIDS) to reduce pain and inflammation.

Surgical Treatment

If the pain persists even after the non-surgical treatment, surgery would be necessary. The excess bone of the heel is removed or filed down to relieve pressure on the bursa and soft tissue. After the surgery, the foot is immobilized in a cast for a week, followed by regular visits to the doctor’s to monitor the recovery.

Cavus Foot (High-Arched Foot): Cause, Symptom & Treatment

When the foot has an abnormally high arch that affects walking and standing, the condition is called Cavus foot. Excessive weight is placed on the heel and ball of the foot which might cause pain and instability. This condition may occur at any age, with one or both feet affected.

Causes

The cause of Cavus foot could be due to a neurologic disorder, an inherited structural abnormality, injury or other medical conditions. For most cases, the condition worsens over time. Thus, it is important to diagnose the cause of the Cavus foot accurately.

Symptoms

The Cavus foot would appear to have a visibly high arch. Calluses might grow on the heel, side or ball of the foot because of the constant weight bearing on those areas. Patient would experience pain when walking and standing. Sometimes, the symptom of Hammertoes might be present, with toes bending downwards. However, if it is not caused by a neurologic disorder, the symptoms might not be visible.

Because the heel is tilting inward, the foot is unstable and more prone to ankle sprains and fractures. If the Cavus foot is caused by a neurologic disorder, patient may be seen dragging the affected foot when walking due to weakness in the muscles known as foot drop.

Treatment

Whether non-surgical or surgical treatment is recommended depends on the severity of the Cavus foot and health condition of the patient. The doctor would run a few tests to determine the severity and diagnose the cause. If the patient has medical conditions like infection, blood vessel disease and diabetes, surgery would not suitable.

Non-Surgical Treatment:

For mild conditions, conservative treatment would first be introduced and observed if improvement progresses over sessions of physical therapy. Patient may have to wear custom orthotic devices or braces to stabilize and cushion the foot and manage foot drop. Otherwise, the shoes may have to be modified accordingly, with higher tops to support the ankles and wider heel bottoms for more stability.

Surgical Treatment:

If the condition is severe or if pain is not relieved with non-surgical treatment, surgery would be needed to correct the Cavus foot. Surgery might be done on the soft tissue to release the tendon or loosen a part of the muscle. If this method is inadequate, surgery might also be done on the bones of the foot. The goal is to flatten the arch so that weight can be evenly distributed along the inside and outside edges of the foot.