Big toe osteoarthritis

Ultrasound guided hallux rigidus steroid injection

Ultrasound guided big toe steroid injection

What is big toe osteoarthritis?

Big toe osteoarthritis is a degenerative condition characterised by the thinning or loss of the special protective tissue lining the bone surfaces at the joints, known as the articular cartilage. This is sometimes associated with episodes of joint lining inflammation, called synovitis. This would result in episodes of acute joint pain, swelling and rigidity. Osteoarthritis is one of the most common conditions in our practice, reported to affect approx. 15% of people worldwide, and it increases in incidence with age.

What are the risk factors for big toe osteoarthritis?

Osteoarthritis is usually a slowly progressive condition due to wear and tear changes to the joint. It results in thinning (or loss) of the joint's protective covering (articular cartilage), resulting in joint pain and inflammation. In advanced cases, the bones may start to rub against each other, a condition referred to as (bone on bone) and can be very painful and restrictive. There is no definitive cause of osteoarthritis; however, there are some recognised predisposing factors:

Previous injury. These could be fractures that extend to the joint surface or injuries to the ligaments of the foot/toes resulting in joint instability and osteoarthritis.
Excessive sports activities that result in overuse, like running, can put extra stress on the joint and predispose to osteoarthritis.
Age. The incidence of osteoarthritis, in general, increases with age. Most patients with big toe osteoarthritis are above the age of 50.
Altered foot or ankle mechanics and lower limb weakness.
Footwear (high heels and narrow shoes at the front) can put extra stress on the big toe, resulting in hallux valgus (the picture below). This can predispose to big toe osteoarthritis.

What are the symptoms of big toe osteoarthritis?

The clinical features of big-toe osteoarthritis include:

Big toe pain. This is usually a deep dull pain or ache within the joint. This can be severe and interfere with daily activities and sleeping. Occasional flares with more intense and sharp pain can also happen, usually due to synovial tissue inflammation episodes (synovitis).
Big toe swelling. The toe may appear puffy and larger when compared to the other side.
Rigid Big toe due to stiffness, pain and swelling. Even touching the joint or trying to move it can be very painful. This is referred to as hallux rigidus.

How can you tell if you have big toe osteoarthritis?

The typical history is a dull joint ache that builds up slowly over months or years. Although the pain may start intermittently, it can persist as the condition worsens. Joint pain and swelling can be brought up sometimes by increased physical activity or a change in the type of activity (for example, hill walking). New Footwear (particularly high heels and narrow shoes at the front) can also cause acute pain exacerbation.

What other conditions can mimic big toe osteoarthritis?

Other conditions that can be confused with big toe arthritis include:

Big toe osteoarthritis vs gout

Gout is an inflammatory condition commonly affecting the big toe and can be confused with big-toe osteoarthritis. It usually presents with sudden big toe pain, redness and swelling. It is caused by the deposition of small crystals (urate or uric acid crystals) within the joint. The uric acid levels can also be elevated in the blood (hyperuricemia); therefore, doing a blood test to check for this is very sensible. Gout is more common in men and can be exacerbated by eating red meat or alcohol).

How to diagnose big toe osteoarthritis?

Big toe osteoarthritis is initially suspected after clinical assessment by a foot specialist. Imaging is vital in diagnosing and ruling out other causes of big toe pain. The initial test would be an ankle X-ray. This can provide the diagnosis and assess the joint alignment and the severity of the arthritis. It is also very useful in ruling out other causes like gout. Your GP can request an X-ray, which can be promptly performed in most NHS clinics or hospitals. In addition, your doctor may order specific blood tests to assess for different types of arthritis, such as inflammatory arthritis (rheumatoid arthritis being the most common example), or other conditions, such as gout.

What is the treatment for big toe osteoarthritis?

Similar to other degenerative joint conditions, treatment for big toe osteoarthritis starts with conservative management, including activity modification and physiotherapy. Other measures to reduce joint inflammation, like ice packs and anti-inflammatory tablets like ibuprofen, can also be used. A podiatrist consultation would be very useful to advise you about your footwear.

Can I have a steroid injection for big toe arthritis?

Cortisone is a strong anti-inflammatory medication commonly used to manage symptoms of osteoarthritis. Its anti-inflammatory effect efficiently manages synovitis and reduces joint pain and swelling. A steroid injection is indicated if your pain is severe and not responding to conservative management.

Ultrasound guided big toe steroid injection

We advise performing joint injections under ultrasound guidance. This ensures accurate delivery of the medicine to the inflamed joint. Evidence shows that ultrasound-guided injections result in better pain relief, fewer side effects and better improvement in function compared to non-guided injections. To learn more, please see our FAQs.

How long will the effect of a cortisone injection last?

Current evidence suggests that cortisone can improve pain and function for up to 3 months, but in some cases, it can last longer. Pain relief duration depends on the condition's diagnosis and severity. The steroid injection will provide a window of opportunity to undergo effective rehabilitation and attempt to address the underlying cause to enhance the pain relief achieved from the injection.

How soon will a steroid injection start to work?

A steroid injection usually takes a few days (1-3) before you notice the effect, although sometimes the pain relief can start on the same day. The injected area will often feel sore for the first few days. This is referred to as (steroid flare) and can be seen after a steroid injection.

What if injection therapy is not helping?

In cases of significant osteoarthritis affecting the big toe that fails to respond to conservative management and ultrasound-guided injection treatment, you may require a surgical referral to a specialist foot and ankle orthopaedic surgeon to discuss the surgical treatment options.