Big toe injuries

With the Fall sports season winding down and the indoor sport season now underway, the importance of understanding and preventing foot injuries is top of 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 from injuries sustained as early as high school sports. 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?
A: Athletes who compete in sports where 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 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?
A: 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?
A: Currently, there are several nonsurgical treatments for hallux rigidus and other toe injuries, starting with shoe and activity modification. Doctors typically bring patients back on the road to recover by placing small pads inside their athletic shoes. The athletes then begin low-impact exercises, such as walking, stationary bicycle 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 nonsurgically.

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

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