Arthritis: What to do when your big toe causes big problems

From eu.lansingstatejournal.com

Hallux rigidus, also known as big toe arthritis, is the most common arthritis found in the foot. In fact, it’s so common that it’s likely either you or someone you know will suffer from this type of arthritis at some point in their life.

While there are a couple of reasons you may develop arthritis in your big toe ─ like genetics, a previous injury, or poor foot alignment from a bunion or having flat feet ─ the most common reason is just normal wear and tear that our feet endure over a lifetime. 

Certain conditions that cause inflammation like rheumatoid arthritis, gout, and autoimmune disorders, can also increase your chances of developing arthritis in your big toe.

“Once you have any pain inside a joint that won’t go away and you can’t explain, it’s time to seek treatment,” said Karl Dunn, DPM, a podiatrist with Compass Orthopaedics who performs surgery at McLaren Greater Lansing.

Pain is a chief complaint when patients visit Dr. Dunn in the office; however, patients can also experience swelling around the joint, a bump, and stiffness in the big toe with the inability to bend it.

“I will see patients in my office for a physical exam, and then we typically do an X-ray to get a good look at the toe joint and the cartilage around it,” said Dr. Dunn. “There are many things that we can do to make it feel better and prolong the need for surgery.”

Most people think that if they visit a podiatrist or orthopaedic surgeon, surgery is the only answer. However, in reality, there are many different options that can be explored before surgery, including injections, over-the-counter medicines, changes in shoe gear, and orthotics.

“If we have exhausted all of the nonsurgical treatments and you are still experiencing pain and other symptoms, then it might be time for surgery,” said Dr. Dunn. “There are many surgical options that are now available for patients who are experiencing arthritis in their big toe.”

Some of these surgical options include:

Cheilectomy ─ where the surgeon will shave down any bone spurs to give your joint better movement. Osteotomy ─ where your surgeon will cut your toe bones to realign or shorten your affected big toe. Arthroplasty ─ a joint replacement. Arthrodesis ─ a joint fusion.

“For forefoot surgery, which includes the front of the foot and toes, most patients are non-weight bearing for two weeks after the surgery and then in a boot or shoe for four weeks,” said Dr. Dunn.

If you have pain in your big toe, talk to your doctor. You may be experiencing arthritis in your big toe, and the earlier you seek treatment, the more likely you are to be able to manage the symptoms with non-surgical options.

https://eu.lansingstatejournal.com/story/sponsor-story/mclaren-greater-lansing/2024/09/27/arthritis-what-to-do-when-your-big-toe-causes-big-problems/75377518007/

Can Psoriatic Arthritis Affect Your Toes?

From healthcentral.com

This chronic disease can cause pain, swelling, and damage to your distal interphalangeal joints. Here's what you can do about it 

If you’re living with psoriatic arthritis, you’re no stranger to joint pain, especially in the smaller joints in your body. Among its many pain points, psoriatic arthritis (PsA) can affect your digits, causing joint aches, swelling, and permanent damage. It often affects distal interphalangeal joints (otherwise known as your toes) and can be really uncomfortable, making walking and mobility in general a challenge.

But you don’t have to take psoriatic arthritis toe pain lying down. Learn what the experts say causes it—then find out what you can do to manage the pain.

Can Psoriatic Arthritis Affect the Toes?

Even though symptoms of PsA vary from person to person, many will observe the disease in their feet. According to the Archives of Medical Science, 50% to 70% of those with psoriatic arthritis experience foot abnormalities. 

                                                                           GettyImages/Doucefleur

For example, swelling of the toes (dactylitis) occurs in more than half (65%) of people with psoriatic disease. “Some of the first signs of psoriatic arthritis may appear in the feet,” says William Spielfogel, M.D., chief of podiatry at Northwell Lenox Hill Hospital in New York City. In addition to being one of the first signs, toe involvement may also indicate higher disease activity and more severe joint damage, according to the Journal of Rheumatology.

What Does Psoriatic Arthritis in the Toes Feel Like?

Psoriatic arthritis can attack your feet in a variety of ways, says Dr. Spielfogel. “The toes may have a sausage-like appearance,” he says, that leads to a deep pain when pressure or weight is applied to them.

“You may also experience pain in areas where tendons attach to bones, for example in the back of the heel and/or the bottom of the heel,” he explains. If your psoriatic arthritis has gone untreated, you may experience multiple swollen joints and even structural damage that can be seen on digital imaging.

What are the First Signs of Psoriatic Arthritis in Toes?

If you suspect your toes are being impacted by your psoriatic arthritis, there are several things to be on the lookout for, according to Dr. Spielfogel:

• Pain when you bend your toes

• Pitting of toenails

• Skin plaques

• Swollen digits

• Tendon attachment pain

• Thickening or lifting of toenails

“Issues that would cause one to suspect psoriatic arthritis would be pain at tendon attachments to bone,” Dr. Spielfogel says, along with swelling and pain. Nail involvement—typically in the form of pitting, thickening and lifting of your toenails—is also an indication of early disease.

“These signs in combination with shiny, scaling plaques on the skin would indicate a suspicion of psoriatic arthritis and should be referred to a rheumatologist for a full work up,” adds Dr. Spielfogel.

Swelling (Dactylitis) in Psoriatic Arthritis

Dactylitis describes swelling or inflammation of an entire finger or toe. This is sometimes referred to as sausage-digits. Dactylitis is about three times more likely to impact the toes than the fingers. Beyond being incredibly uncomfortable, dactylitis may also indicate more severe disease.

In a 2022 study, researchers found that those who had early onset of psoriatic arthritis (before age 40) were more likely to develop dactylitis, and dactylitis has been associated with more severe radiological damage. Among those with early onset, 45% had dactylitis compared to only 8% of those developing psoriatic arthritis after the age of 40.

Of equal importance, dactylitis may provide your doctor with a host of clues about the course of your psoriatic arthritis. “Dactylitis is a unique feature and helps define the spectrum of the disease,” says Elizabeth Schulman, M.D., a rheumatologist at Hospital for Special Surgery in New York City. “The presence of dactylitis certainly can help guide treatment.” Similarly, observing any changes in the toes can be an indication of disease advancement, which may help inform the treatment decisions you and your provider make.

“People tend to overlook the health of their feet in general and toes in particular—but toe involvement can raise a red flag, for sure, signifying sub-optimal treatment for psoriatic arthritis,” explains Dr. Schulman.

Hammer Toes in Psoriatic Arthritis

A hammer toe refers to a deformity in the shape of the toes. “The toe is typically contracted (bent) at the joint, thereby resembling a hammer,” Dr. Spielfogel explains. How does it happen? Each of us has a lining that covers our joints, known as synovium. This lining lubricates the joints. If the lining swells and becomes inflamed from your psoriatic arthritis, it can lead to joint destruction and weakened ligaments and tendons. These weaknesses can then cause joint deformities such as hammer toe. “Hammer toe can be associated with psoriatic arthritis, but not always a sign of it,” says Dr. Spielfogel.

How to Manage Psoriatic Arthritis Toe Symptoms

Toe involvement can be more than uncomfortable—it can make walking and standing next to impossible. Fortunately, there are things you can do to get back on your feet sooner than later. Start with these tips.

Follow Your Treatment Plan

“Working with your provider to get your disease under control is the first step in managing PsA toe involvement,” says Dr. Schulman. If you are waiting for a new treatment to work, non-steroidal anti-inflammatory drugs (NSAIDs) may help to reduce symptoms, she adds.

Do Joint-Friendly Exercises

Exercising with psoriatic arthritis toe involvement can seem beyond challenging. Looping in a physical therapist can be helpful in pain reduction, joint mobility, and providing exercise ideas that don’t involve extra stress on the toes (hydrotherapy as an example).

Consider Cold Therapy

The thought of immersing your foot into an ice bath may not sound like fun. It is also not for everyone, according to the journal Pain and Therapy. However, for a certain segment of the population, cold therapy (also known as cryotherapy) has demonstrated effectiveness with swelling reduction related to rheumatic diseases.

Wear Comfortable Shoes/Orthotics

“Switching to supportive footwear can help with the mechanical stress on the feet,” says Dr. Schulman. Give your toes a little extra breathing room by wearing, at least temporarily, a shoe with a wider toe box (possibly a man’s sneaker sized for a woman, for example). This may reduce further aggravation to the toes, which can compound their already inflamed state.

Keep Your Toenails Trimmed

If psoriatic arthritis has impacted your toes, nail care is paramount. Keeping your toenails as short as possible will help prevent them from rubbing or pressing against the end of your shoes, which will apply extra pressure to your toes, making your pain worse.

When to See a Doctor

Dr. Schulman says that if there is toe involvement, this is a time to let your provider know right away. “Not only does this indicate active psoriatic arthritis, but it can also indicate other conditions such as an infection,” she says. “If your psoriatic arthritis is impacting your toes, it is important to obtain a prompt evaluation from your provider.”

Bottom line? Psoriatic arthritis can attack multiple joints all over your body. But when it strikes your toes, the pain can literally be immobilising. The sooner you see your doctor and start on treatment, the faster you’ll be able to walk pain-free.

https://www.healthcentral.com/condition/psoriatic-arthritis/psoriatic-arthritis-toes 

What It Means When Your Big Toe Cracks

From healthdigest.com

As kids, we all got a little grossed out when someone cracked their knuckles. As adults, some of us might have that same popping or cracking of the toes or other joints. We might be the only ones who hear it or others might cringe as they hear the sound from several feet away. The name of this condition sounds equally as cringeworthy — crepitus. According to Arthritis Health, you could have crepitus for most of your life or you could notice it as you get older.

What often happens when your toe cracks is an air bubble gets trapped between your joints. You'll hear a popping or cracking sound when this air bubble pops. Your tendons and ligaments are also moving around your joints and could create a snapping sound when moving around the bone. If this cracking or popping doesn't cause pain, crepitus isn't usually a concern. However, if you experience other symptoms when your big toe cracks, it could indicate other conditions.

A big toe cracking could mean arthritis

According to New York Foot Health, cracking or popping in your toes can be a problem if you have other symptoms — such as pain that worsens with activity, stiffness, joint swelling, limited range of motion, redness around the joint, difficulty bearing weight or walking, and a feeling of warmth in the joint. If you experience symptoms like these, your cracking big toe could indicate arthritis. Although arthritis is a general term for joint problems, certain types of arthritis could specifically impact your feet such as osteoarthritis, rheumatoid arthritis, or gout.

You're at a greater risk for arthritis if you're older, overweight, or wear tight-fitting heels, according to Northeast Orthopaedics and Sports Medicine. You're also more likely to have arthritis if members of your family have had arthritis. 

You can ease arthritis pain in your feet by using a topical treatment that has capsaicin, such as Icy Hot. Wiggling your toes, taking non-steroidal anti-inflammatories (NSAIDs), and getting foot massages can also help with arthritis symptoms. You might also consider swapping your footwear to support your feet.

Other reasons for your big toe cracking

Northeast Orthopaedics and Sports Medicine says that Lyme disease, HIV, chikungunya, and other infections could have symptoms similar to arthritis. Lupus occurs when the body's immune system attacks its own healthy tissues and could cause pain in your toes and other joints. Pain in your toes could also indicate vasculitis, where your blood vessels have inflammation. Morton's neuroma can cause pain in your toes because of inflammation in the tissues surrounding a nerve in your foot.

Any cracking of your big toe (or any toe) could also mean a broken toe, according to Feet First Foot Care. A broken toe might make a cracking sound, and you'll also experience pain and swelling. A podiatrist or other medical professional can diagnose a broken toe through an X-ray. Small fractures in a toe might heal by taping it to an uninjured toe or wearing a shoe that immobilizes the injured toe, according to Mayo Clinic. You might need to wear a cast to allow a broken toe to heal.

https://www.healthdigest.com/1272393/what-means-big-toe-cracks/

Exercises to Help With Arthritis in the Big Toe

From verywellhealth.com

Exercises can help with arthritis in the big toe because they increase range of motion and strength. Stretching and strengthening exercises can also help your toes become more flexible and relaxed, effectively reducing stiffness and risk of injury and improving joint function. Depending on your arthritis severity, you may be restricted to shorter and gentler exercises at first, but sticking to an exercise routine will help increase your joint mobility. Once your active range of motion (AROM) is better, you will be able to increase exercise length and intensity. 

Exercises

Your doctor or physical therapist will help you determine which exercises are safest and most suitable for your big toe pain caused by arthritis. They will also offer guidance as to how many sets and reps you should aim for initially and over time. 

The American College of Rheumatology recommends the following for exercising with arthritis:  

• Active range of motion exercises should be performed for at least two sets of 10 repetitions.
• Stretching exercises should be performed at least four to five days a week, with each stretch lasting for about 20 to 30 seconds and repeated two to three times. 
• Strengthening exercises for most people should be done four to five days a week, with eight to 10 repetitions for each exercise. Older patients may find 10 to 15 repetitions with less resistance to be more appropriate. 

Peter Dazeley / Getty Images

Toe Pulls

Toe pulls are basic stretching exercises that help increase mobility in the big toe joints. Mobility here is essential for maintaining a normal walking pattern, or gait.

To perform this exercise:

• Put your affected foot up on a stool or a chair. 
• Stabilize your foot by holding it just proximal to (nearer to the centre of) the area where the toes meet the foot. 
• Using your other hand, hold your big toe and gently pull it forward and flex it down toward the sole until you feel a gentle stretch. Hold this for 10 to 20 seconds before letting go. You can also hold it for longer, as long as you don’t get cramps in your fingers.
• Optional: Gently massage the arch of your foot with the other hand during the stretch.

Big Toe Extension Stretch

This exercise is particularly useful for people with big toe stiffness and heel pain caused by plantar fasciitis. The end goal is being able to stretch your big toe at a 90-degree angle toward your ankle. Achieving this may take several days or weeks of exercise.

To perform this exercise:

• While sitting in a chair, put your affected foot up on your other knee. 
• Hold the heel of the affected foot in one hand and use your other hand to pull the big toe back toward the ankle until you feel a gentle stretch along the bottom of your foot. 
• This stretch should be held for at least 15 to 30 seconds at a time. If you’re having difficulty, try shorter hold times where you put the pressure on and off more frequently. 

Towel Curl

The towel curl helps build strength in the big toe and should be attempted when you have reasonable joint mobility. After you’ve adapted to this exercise while sitting, you can increase the intensity by doing the exercise while standing.

To perform this exercise:

• While sitting, place a small hand towel on the ground and rest your affected foot on top of it. 
• Scrunch the towel toward you by curling your toes, and then push the towel away from you by spreading out your toes.

Toe Press, Point, and Curl

This exercise engages your whole foot, and helps improve mobility, strength, and overall balance. Research has shown that toe curl exercises can improve quality of life, reduce pain, and improve ability to perform daily activities. 

To perform this exercise:

• Sit in a straight-back chair with your feet flat on the floor. 
• Press your toes into the ground and raise your heel. 
• Point your toes while keeping your heel raised (first and second toes stay touching the ground). 
• Curl your toes under so the tops of the toes are touching the ground, and keep your heel raised.
• Cycle through the three movements, pausing to hold each position for five seconds. (You can do this one foot at a time or with both feet.)

Toe Splay

Toe splaying targets the muscles within your foot, helping you gain control and strength in this area.

To perform this exercise:

• Sit in a straight-back chair with your feet resting on the floor.
• Spread your toes out as wide as you can and hold for five seconds. (You can do this with one foot at a time or with both feet.) 
• If that’s too easy, you can loop a hair tie or rubber band around your toes before you spread them out to add some resistance. 

Marble Pickup

This strengthening exercise can also be done with small household items such as dice. Begin with four or five and perform the exercise on each side, eventually working your way up to the below mentioned 10 to 20 marbles.

To perform this exercise:

• Sit down in a chair. 
• Set 10 to 20 marbles out in front of you to one side of the chair (either in bowls or on a carpet). 
• Using the toes of one foot, grab one marble at a time and move it to the other side of the chair. 
• Once you’ve moved all the marbles, do the same thing to return them one by one to where they were when you started.

Toe Salutes

This is another great stretch that builds strength. The goal is to go slowly to remain in control of your other toes, which should remain on the ground. 

To perform this exercise:

• Sit in a chair with your feet relaxed on the ground under your knees.
• Raise the big toe of your right foot off the ground and hold it there for five seconds while keeping the other toes on the ground. 
• Return your big toe to the ground. 
• Then lift your other four toes off the ground while keeping your big toe on the ground and hold them there for five seconds. 
• Finally, return them to the ground. Repeat the exercise with your left foot.

Toe Squeezing

Toe squeezing targets the muscles within your foot and strengthens them. These muscles play an essential role in overall foot flexibility, stability, and shock absorption when walking or running. 

To perform this exercise:

• Place foam or flexible plastic separators between your toes (you can find these online sold as pedicure toe separators). 
• Squeeze your toes together for 10 seconds, then relax.

Resisted Toe Flexion

This strengthening exercise may require some mobility work before attempting. If you experience pain while trying this, stop and return to gentler exercises aimed at increasing range of motion. If you find this exercise too easy with a light-resistance band, trade up for a higher-resistance option.

To perform this exercise:

• Wrap a light-resistance band around the back of your big toe. 
• Hold the ends so that there’s light tension on the band when your toe is pointed up toward your ankle.
• Push your toe against the band, back toward the floor to be in line with the other toes.

A Word From Verywell

Exercises can help you improve the mobility and range of motion of your big toe if you have arthritis in this joint. It can even help relieve some of your pain. Consult your doctor before beginning any new exercise routine, and always listen to your body when engaging in physical activity. It’s better to start slowly rather than try everything at once and risk injury or making your condition worse. If you have any concerns, talk to your doctor or physiotherapist. They will be able to suggest different kinds of exercises or modify them to fit your needs.

https://www.verywellhealth.com/arthritis-big-toe-exercises-5115689