Arthritis of the 1st Metatarsophalangeal Joint and Arthrodesis

What is arthritis of the 1st metatarsophalangeal joint?
Metatarsophalangeal arthritis is the most common form of arthritis and occurs in people between 30 and 60 years of age. It is a condition that leads to reduced range of motion in the 1st metatarsophalangeal joint, which is the big toe of the foot.

What are the types of 1st metatarsophalangeal joint arthritis?
Type 1. There are mild lesions and minimal osteophytes.

Type 2. Moderate lesions are observed and the interarticular space is narrowed. Also formed in the area.

Type 3. There are severe lesions and the mediastinal space is narrowed considerably. In addition, there is extensive formation of new bone.

What are the causes and risk factors for the development of arthritis of the 1st metatarsophalangeal joint?
The exact causes remain unknown. Certainly, there are possible causes of the condition:

Injuries to the area
Injuries to the joint
Anatomical abnormalities of the area
Anatomical anomalies of the joint
The big toe is inclined at the proximal phalangeophalangeal joint
Family history
Inflammatory diseases, such as rheumatoid arthritis
What are the symptoms of developing arthritis of the 1st metatarsophalangeal joint?
It causes pain and stiffness in the metatarsophalangeal joint and can worsen over time. Also, in some people the condition does not worsen, while in others stiffness and pain is noticeable. Among other symptoms are the following:

Pain that worsens on walking and running
The patient finds it difficult to put on shoes
Swelling around the joint
It is difficult to walk and it is difficult to use the shoes
Hardness in the big toe
Patient is unable to move the big toe
How is arthritis of the 1st metatarsophalangeal joint diagnosed?
The specialist orthopaedic surgeon will examine the range of motion of the toe joint. Also, an X-ray may show any bone abnormalities.

How is arthritis of the 1st metatarsophalangeal joint treated?
Conservative treatment
To relieve the patient’s pain, the specialist orthopaedic surgeon will recommend conservative treatment. More specifically:

Appropriate shoes. They must have enough room for the toes. Also, the patient should avoid high heels.

Restricted movement of the feet. Avoid strenuous physical activities, such as jogging.

Taking analgesic medications, such as paracetamol and non-steroidal anti-inflammatory drugs.

Injections: Corticosteroid injections relieve pain.

If conservative treatment fails, then the specialist orthopaedic surgeon will suggest other solutions, which involve surgery. If the case is not severe, then hymenectomy and chelectomy are applied. This means that the osteophytes are removed from the joint.

As for more severe cases, arthrodesis is applied. This is surgery on the front of the foot and is performed under general or partial anaesthesia. More specifically, the articular cartilage is removed from the peripheral end of the 1st metatarsal and from the base of the proximal phalanx.

The bones are then placed in the correct position and fixed either with a plate or with two cross-head screws. At the same time, bone grafts may be used between the articulating surfaces.

Of course, during this procedure, the movement of the big toe is removed, but the pain is eliminated. Note that walking shows improvement in propulsive power, loading and stability of the limb.

What happens after surgery?
Suture cutting is done 15 days after. In addition, for a few weeks, the patient wears a special metatarsal unloading splint.

Can there be any complications?
If the patient chooses a qualified orthopaedic surgeon, there will not be any. Of course, should they occur, they are as follows:

Loosening of the materials
Fragmentation of the articular surfaces
The Orthopaedic Surgeon, Dr. Antonios Pettas, is specialized in the field of Orthopaedic Surgery and Traumatology, as well as in the surgery of the foot. For early diagnosis and treatment, contact him.