When Arthritis Inflames the Big Toe…Which Athletes are Vulnerable?

Foot injury expert explains who is at risk for "turf toe," an aggravating and potentially crippling injury down the road

NEW YORK, N.Y.—November 21, 2007 

With the fall sporting season winding down and the indoor sporting season approaching quickly, the importance of understanding and preventing foot injuries is at the top of the mind for thousands of athletes around the country.
 
One injury that has perplexed many athletes and physicians alike is a form of degenerative arthritis known as hallux rigidus that can develop over time at the joint by the base of the big toe. According to the American Academy of Orthopaedic Surgeons (AAOS), hallux rigidus usually develops in adults between the ages of 30 and 60 years as a result of previous injuries, some sustained while engaging in sporting activities as early as high school. No one knows why it appears in some people and not others.

In the question and answer interview below, foot and ankle specialist David S. Levine, M.D., assistant attending orthopedic surgeon at Hospital for Special Surgery in New York, explains that physicians typically see a sharp increase in big toe injuries this time of year.

Q: What types of athletes are prone to hallux rigidus?

Athletes who compete in sports that require making continuous cutting, loading and extending movements with their feet are more susceptible to repetitive micro traumas and sprains that occur at the joint of the toe.  Sometimes these injuries are known as ‘turf toe’ and lead to the development of bone spurs.  All of this can lead to hallux rigidus if not properly treated.  Sports played on open and artificially surfaced fields, such as soccer and football, produce the highest numbers of toe injuries that can ultimately manifest into hallux rigidus.

Q: Does hallux rigidus need special medical attention, or is it just a nagging injury that usually goes away?

Hallux rigidus injuries aren’t injuries where an athlete can simply tape up and play through it. There are serious consequences for not properly administering to big toe injuries that can debilitate an athlete in years to come.

Q: What are some of the options for athletes who experience this injury?

Currently, there are several non-surgical treatments for hallux rigidus and other toe injuries, starting with shoe and activity modification.  Doctors typically bring patients back on the road to recovery by placing small pads inside their athletic shoes.  The athletes then begin low-impact exercises, such as walking and using stationary bicycles and elliptical trainers, to circulate blood flow.  Considering the big toe’s distance from the heart, injuries in this area take a longer time to heal thanks to slower circulatory patterns, which is why it is important to get patients moving as quickly as possible.

Physicians are also finding the use of carbon fiber inserts to athletic shoes as a great advance in treating toe injuries.  According to Dr. Levine, physicians typically place padding that is designed to stop movement under the joint of the big toe, known as a Morton’s Extension.  Anti-inflammatory and corticosteroid injections are also options to treat pain from toe injuries non-surgically.

Q: Are there surgical options for patients with hallux rigidus?

Surgical treatment is reserved for patients who do not respond to medication and orthotics.  I classify the surgeries in two categories; those whose joints are still salvageable and those who need to remove the joint.  For those who want to save the joint and continue to experience full mobility and less pain, surgeons will perform a cheilectomy, which is the shaving of the big toe joint. This surgery will allow for full joint mobility. However, it effectively serves as a time delay, as patients tend to experience pain later, once the bones begin to grow.

The other surgical option is joint fusion, or arthrodesis.  Surgeons will fuse the two adjacent bones together and make them grow as one. Patients experience lasting pain relief by eliminating arthritic joints and mobility is improved considerably.

About Hospital for Special Surgery
Founded in 1863, Hospital for Special Surgery (HSS) is a world leader in orthopedics, rheumatology and rehabilitation. HSS is nationally ranked No. 1 in orthopedics, No. 3 in rheumatology by U.S. News & World Report (2007), and has received Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center. In the 2006 edition of HealthGrades' Hospital Quality in America Study, HSS received five-star ratings for clinical excellence in its specialties. A member of the NewYork-Presbyterian Healthcare System and an affiliate of Weill Medical College of Cornell University, HSS provides orthopedic and rheumatologic patient care at NewYork-Presbyterian Hospital at New York Weill Cornell Medical Center. All Hospital for Special Surgery medical staff are on the faculty of Weill Medical College of Cornell University. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.

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