What Is Arthritis in the Toes?

Last updated: 11-21-2020

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 What Is Arthritis in the Toes?

Arthritis in the toes is chronic inflammation of the joints in the forefoot. The joint most often affected is the metatarsophalangeal (MTP) joint, which connects the big toe to the rest of the foot. Symptoms of toe arthritis are similar to those of arthritis that affects other joints: tenderness, swelling, stiffness, and pain. The most common causes of toe arthritis are wear and tear (degeneration) of the cartilage that cushions the bones that form joints, as occurs in osteoarthritis (OA) and rheumatoid arthritis, (RA), an autoimmune disease. Damage caused by an injury or gout also can cause toe arthritis. Treatment depends on the cause and severity: Icing and over-the-counter (OTC) pain medication can relieve swelling and pain, but in severe cases orthotics, physical therapy, or even surgery may be needed to restore loss of function.
Symptoms of Toe Arthritis

Arthritis symptoms may come and go or be persistent and debilitating. You may wake up one morning with pain and swelling in one or more toes, or you may notice a gradual progression of mild achiness to increasing discomfort and changes in the appearance of your toes over time.

Your symptoms also will depend in part on the type or cause of your toe arthritis, but typically you will experience:

Pain and soreness at the base of the big toe: This is likely to flare up when you're standing or walking and subside once you get off your feet. After intense activity, it may take hours, or even days, to abate.1
Swelling: Toe joints are tiny: The accumulation of even a small amount of fluid may cause toes to feel "full" or be hard to bend.
Restricted movement: Range of motion may be limited because of swelling as well as loss of cartilage between the bones of the joints that allow them to move smoothly.2 Pain and stiffness may flare up during cold, damp weather.3
Redness and warmth: Inflammation causes blood vessels to widen in order to bring more blood to affected areas, causing them to be warm to the touch and reddish in appearance.
Deformities: These include bone spurs (osteophytes), bunions, mallet toes, hammertoes, and others.2 They can affect how you walk and also, because there's little soft tissue surrounding the toe joints to hide them, alter the appearance of the foot. In some people, deformities lead to pressure sores, calluses, and blisters.
Numbness: Swelling and changes to structures in the foot can compress nerves, resulting in numbness, burning, or tingling.4
Clicking or popping sounds: Toe joints may make sounds as the cartilage that usually cushions the adjoining bones in a joint wears away, allowing hard bone surfaces to clack together.

Signs and Symptoms of Arthritis
Types and Causes

There are many different types of arthritis. Among them:

Osteoarthritis: Although considered non-inflammatory, OA does involve some degree of inflammation. It develops when the cartilage that forms a cushion between the bones of joints wears away due to time or injury (such as stubbing a toe).5 Osteoarthritis of the big toe is called hallux rigidus.6
Rheumatoid arthritis: Inflammation, and therefore redness, warmth, and swelling, are more pronounced in RA. Because the entire body is affected, you may experience fatigue and other systemic symptoms.
Gout, also known as gouty arthritis, is caused by the formation of uric acid crystals in a joint (most often the big toe). The condition is associated with genetics and kidney disorders, but diet, alcohol use, and obesity are contributing risk factors.
Psoriatic arthritis: Like RA, psoriatic arthritis is an autoimmune disease in which characteristic skin lesions precede symptoms of arthritis.7

Risk factors for toe arthritis include obesity, as excess pounds can stress weight-bearing joints, 8 and frequent and prolonged wearing of tight fitting high-heeled shoes.9 There also is some indication toe arthritis can run in families.3
Diagnosis

If you experience symptoms of toe arthritis, you can see your regular doctor, although an orthopedic specialist may be able to diagnose you most expediently. The diagnostic process will likely involve:

A medical history
A physical examination of your foot
X-rays to observe the bony structures of your toes, evaluate cartilage loss, and visualize bone deformities. It's possible you'll have X-rays taken while you're standing in order to highlight how bodyweight affects the structures in your foot.
Although seldom necessary, in some cases advanced imaging such as computed tomography (CT scans) or magnetic resonance imaging (MRIs) may be used.
Blood tests for certain proteins, antibodies, or uric acid that might suggest rheumatoid arthritis or gout are performed.
Joint aspiration, in which fluid in a joint is obtained to examine for infection or uric acid crystals. The results can rule out other medical conditions or other forms of arthritis.

Treatment

Treatment for arthritis of the toes almost always begins with simple steps. Rarely is it necessary to immediately jump to surgical correction.10
Cold and Heat Therapy

For significant inflammation, especially after activity or a long day on your feet, icing can deter blood flow and relieve swelling and redness. Before activity, the application of heat can warm and loosen muscles in the lower foot allowing for easier movement of the toes.
Anti-Inflammatory Medications

Oral non-steroidal anti-inflammatory medications (NSAIDs) can help relieve swelling and also alleviate discomfort associated with toe arthritis. These drugs commonly include over-the-counter medications like Advil (ibuprofen) and Aleve (naproxen) but may sometimes include prescription medications like Celebrex (celecoxib), Voltaren (diclofenac), or nabumetone.

These medications can be taken regularly to prevent and control pain or only when arthritis flares up.

Some studies show that turmeric, an herb from the ginger family, may have powerful anti-inflammatory properties that can help with arthritis pain.11 Always discuss any new medications or herbs with your doctor as there are always possible side effects.10
Cortisone Injection

An injection of cortisone puts a powerful anti-inflammatory medication directly at the site of inflammation.10 While cortisone injections around the toes are sometimes uncomfortable, they can lead to very rapid and effective pain relief. The results tend not to be permanent, but if you have a significant flare up that does not settle down with other treatment, a cortisone injection may offer dramatic improvement.
Footwear

Invest in high-quality shoes and devices that provide arch support, shock absorption, and other features that can help to protect toes and prevent exacerbtion of toe arthritis symptoms. Consider:

Shoes with rocker soles—thicker-than-normal soles—and a curved heel.12 A shoe with this type of sole, common in athletic footwear, reduces pressure under the big toe joint by 12% in people with OA, research shows.13
Orthotics and inserts that can help reposition the foot in a shoe, thereby relieving pressure on toes. The simplest inserts—accommodative inserts—do not correct a deformity but take pressure off of areas of the foot that are uncomfortable, thereby making normal activities bearable. Gel inserts are one example of inserts that cushion the foot, relieving discomfort.
Custom orthotics. If accommodative inserts don't get results, semi-rigid and rigid insoles can correct deformities, redistribute weight, and correct mechanics of the foot. These types of orthotics generally need to be custom designed to accommodate your specific anatomy.

By providing a more rigid base, custom orthotics can take pressure off of arthritic joints by controlling how much motion occurs at a specific joint.

The advantage of a custom insert is that it can correct biomechanics at specific problematic joints while allowing as much normal foot movement as possible. Special rocker-bottom soles can be also be attached to shoes and help provide normal movement as you walk.
Lifestyle Modifications

Maintaining a healthy body weight may be key to both preventing and treating arthritis in general: Studies show that people with a relatively high body weight develop arthritis at younger ages are prone to more severe arthritis.14 Extra pounds put more force on your joints, leading to wear and tear, and can also cause more inflammation throughout the body. For the obese, a weight loss of just 10% of body weight can result in significant improvement in symptoms.
Joint pain and obesity

In addition to losing weight, physical therapy and specific exercises can help with foot pain.13 In general, regular moderate exercise helps maintain joint function while reducing pain and fatigue and relieving stiffness.15 Talk with your physical therapist to determine what exercise would be best with the least wear and tear.
Surgery

Although seldom necessary, there are a number of surgical procedures for treating arthritis in the toes.

Cheilectomy: Removal of bone spurs that have formed around arthritic joints to improve range of motion. The downside is that the procedure leaves worn-out cartilage in place and bone spurs can return down the road. This procedure is usually performed on the big toe and less commonly on the lesser toes.
Fusion: Also known as arthrodesis, a procedure in which bone growth is stimulated across the joint, leaving it permanently stiff but without pain. This procedure is generally performed on the lesser toes.
Resection: Removal of an entire joint, leaving behind a "floppy" joint that moves easily but has little stability.
Arthroplasty: Total replacement of a troublesome joint

Causes of pain at the big-toe joint
A Word From Verywell

Your toes may seem like minor players in your overall health and well-being, but if you've been diagnosed with arthritis in these small joints you're well aware of how painful and debilitating it can be. Managing toe arthritis may be challenging but is entirely do-able. Because it's a condition that can get worse with time and inattention, the most important thing you can do is see your doctor as soon as you suspect something is wrong. Prompt diagnosis can get you started on a treatment plan leading toward getting you back on healthy, pain-free feet.


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