Are walking and running painful?

Author: Eman Elmi, DPM, podiatrist and podiatric surgeon

Arthritis may be the Culprit and Replacing Your Big Toe Joint May Be The Answer

On almost any day, people of all ages are enjoying Marin County’s numerous trails, creeks, parks and preserves. With a social and physical environment that embraces and celebrates good health and activity, it’s no wonder that for the past five years Marin County has been ranked the healthiest county in California.

Among people who lead healthy, active lifestyles, however, many find their exercise routines restricted due to pain, especially in areas of the body such as the knees or feet. 

One of the common areas of foot pain is in the big toe joint where arthritic changes have occurred as a result of prolonged weight bearing activity, typically seen in patients who run, hike or engage in certain sports.  Arthritis, which is often seen as early as 30 years of age in adults, is the most common cause of this pain, but other causes include metabolic bone disease, chronic gout, injuries and other inflammatory processes. 

Arthritis or simply years of use may cause the joint, especially the cartilage between the joint, to start to wear away. Patients come to us with several symptoms: stiffness in the big toe joint;  difficulty in obtaining full range of motion; swelling around the joint, particularly after exercise or long periods of standing or walking;  discomfort when wearing shoes;  and pain in the joint when pushing-off the toes during a regular walking cycle

Ben, 52, one of our patients at North Bay Podiatry, has been a runner for almost 30 years. He first sought treatment for foot pain about ten years ago.  Because his big toe pain had not reached a severe stage, we prescribed orthotics for his running shoes. They worked for Ben -- for awhile. Then the pain increased until he could no longer run.  The arthritic changes to his big toe had increased causing him much additional pain and restricted movement. We were able to offer Ben the surgical option of joint replacement in the big toe. After the 45-minute outpatient procedure, Ben was able to walk out of the surgery center the same day and has happily returned to the exercise he loves.

Ben’s story shows that, fortunately, pain in the big toe joint can be treated. The podiatrist can utilize several modes of treatment, ranging from conservative – including physical therapy, medications, orthotic footwear – to surgery, including replacement of the big toe joint.

Joint replacement procedures drastically improved

Like other total joints replacement procedures in the body, such as the knee and hip, the technology has drastically improved over the past decade or two. The total joint replacement procedure for the big toe joint now has a consistently high success rate, and allows patients to be pain free and get back to their active lifestyle in a timely fashion.

Surgical intervention is usually reserved for late stage big toe joint arthritis. The two surgical options, with pros and cons for both, are fusion of the joint, or arthroplasty of the joint with placement of an implant. To determine if a patient is a candidate for joint replacement in the big toe, the podiatric surgeon will do a thorough physical exam of the joint, in conjunction with X rays which will show the extent of arthritic damage to the joint.  Typical x-ray findings include decreased joint space as well as arthritic changes all around the joint.

During the procedure, the surgeon removes arthritic damage to the joint and prepares it for implantation of an artificial joint with a flexible hinge. The patient can bear weight on the operated foot that same day and resume motion postoperatively wearing a postoperative shoe.  After about 3 to 4 weeks, the patient “graduates” into athletic shoe gear and gradually gets back to his or her regular activities.

Arthritis of the big toe joint can be a significant cause of pain and disability for many. Recent advancements in medicine and surgery have changed the way doctors treat patients with arthritis, and have allowed for shorter recovery times with minimal postoperative discomfort. Foot health and functionality play an integral role in staying active and staying healthy. Total joint replacement surgery for the big toe joint can remarkably change one’s life and longevity.

Signs of arthritis in the big toe joint

  • Pain in the toes or on the big toe alone when trying to move.
  • Stiffness in the joints, difficulty bending and stretching.
  • Swollen toes, possibly red and warm to the touch.
  • A grinding noise due to worn cartilage and the bones of the joint rubbing together
  • A big toe that looks bigger than it used to. A big bump similar to a bunion
  • Redness and tenderness around the joint
  • Walking becomes extremely painful and difficult.