Nonsurgical Treatment
Treatment usually starts with anti-inflammatory medications to reduce pain, swelling, and redness. Special shoes with reduced bending at the toe, or rocker soles, help minimize stress on the MTP joint. A metal brace in the sole may also limit motion and reduce discomfort.
Cortisone injections may provide temporary relief, sometimes used alongside footwear modifications. As with any joint injection, a small risk of infection exists.
Surgical Treatment
Surgery is considered if nonsurgical options fail. Procedures vary depending on the severity of the condition:
Cheilectomy
Bone spurs on the top of the joint can cause pain when the big toe bends upward. A cheilectomy removes these spurs, allowing better motion and reducing discomfort. The surgeon makes a small incision, removes the bony outgrowths, and closes the skin to heal.
Joint Fusion (Arthrodesis)
Fusion of the MTP joint is recommended to relieve severe pain. The joint surfaces are removed, and the two bones grow together into one solid bone. A rocker-soled shoe is typically needed post-surgery to improve walking mechanics. Fusion usually takes about three months to become fully solid.
Artificial Joint Replacement
For moderately affected joints, the arthritic surface can be replaced with a small artificial joint made of metal, ceramic, or plastic components. This preserves some motion but may require revision surgery later, as implants have a limited lifespan. Surgeons fit the implant carefully to ensure proper alignment and joint function.
Other Procedures
Some procedures are variations or combinations of the above, such as combining cheilectomy with phalangeal osteotomy or interpositional arthroplasty, where a tendon spacer is placed to relieve joint pressure.