Arthrosis of the 1st metatarsophalangeal joint is a progressive pathology affecting cartilage and bone tissue. It is characterized by stiffness of the big toe and the entire foot, deformation of the joint, and pain that intensifies when walking. Unlike arthrosis of other localizations, destructive and degenerative changes in hyaline cartilage are often found in young people. The causes of the disease are hypermobility of the joints, excessive stress on the foot, including wearing high-heeled shoes.
Healthy and damaged joint.
To diagnose arthrosis, instrumental methods are used, the most informative of which is radiography. An integrated approach to the treatment of pathology is practiced: taking NSAIDs, intra-articular injections of glucocorticosteroids, immobilization of the thumb, and physiotherapy. If conservative treatment is ineffective, the patient is prepared for surgery.
Symptoms
- Pain. At first, the pain appears after physical activity and disappears after rest. Over time, the pain becomes constant and limits the daily activity of patients.
- Impaired joint mobility. At the beginning, dorsiflexion is limited, then plantar flexion. As the disease progresses, the range of motion decreases. In the later stages of the disease, complete immobilization of the joint occurs (ankylosis).
- Swelling at the base of the first finger, redness.
- Lameness
Basic treatment methods
From the very beginning of treatment, patients are advised to wear special orthopedic devices to ensure the correct anatomical position of the foot. Interdigital inserts, instep supports, and pads of varying stiffness are used to prevent further deformation of the metatarsophalangeal joint. Orthopedic devices also help to avoid the development of an inflammatory process due to rubbing of soft tissues.
Latch.
To increase the effectiveness of treatment, patients are advised to give up bad habits that significantly worsen the blood supply to the lower extremities. It is necessary to change the diet: exclude salt, herbs and spices, fast food, fatty meats. But you need to drink at least 2.5 liters of liquid per day, but only in the absence of pathologies of the urinary organs. Drinking large amounts of fluid helps accelerate the removal of tissue breakdown products, waste products, and toxic chemical compounds from the joints.
If conservative treatment does not bring results within several months, surgery is performed. The doctor decides which method will be used. The operation is performed with complete removal of the phalanx or only excision of bone growths. In some cases, the joint is completely immobilized in a functionally advantageous position.
Pharmacological drugs
Daily, single doses of medications and the duration of their administration are determined by an orthopedist or traumatologist. To eliminate acute, piercing pain, glucocorticosteroids are used, solutions of which are injected into the joint cavity. They are combined with analgesics and anesthetics: Lidocaine, Novocaine. Glucocorticosteroids (Triamcinolone, Diprospan, Dexamethasone) are hormonal drugs that are characterized by hepatotoxic, gastrotoxic, nephrotoxic effects. Therefore, they are canceled after 2-3 days, replacing them with non-steroidal anti-inflammatory drugs in injection solutions or tablets:
- Nimesulide;
- Diclofenac;
- Meloxicam;
- Ibuprofen;
- Celecoxib.
Arthrosis of the metatarsophalangeal joint is a chronic pathology that cannot yet be completely cured. This means that when it worsens, pain occurs that is relieved by taking NSAIDs. To minimize the gastrotoxic effect of these drugs, you should definitely take proton pump inhibitors along with them, the best known of which is Omeprazole.
Pain due to arthrosis of the 1st or 2nd degree can be eliminated with ointments, creams, gels with NSAIDs. These are Fastum, Voltaren, Artrosilene, Dolgit, Nise, Ketorol, Indomethacin, Artrosilene, Finalgel. They are applied in a thin layer to the phalanx and rubbed in with massaging movements 2-3 times a day. After stopping inflammatory processes, orthopedists include in therapeutic regimens external agents with a warming, locally irritating and distracting effect:
- Finalgon;
- Apizartron;
- Viprosal;
- Capsicam;
- Efkamon.
They are used in small quantities, as they cause a fairly strong burning sensation. Under the influence of heat, blood flows into the affected bone and cartilage tissues. It saturates all joint structures with nutrients and biologically active substances, preventing their destruction.
For arthrosis of any location, patients are advised to take chondroprotectors for several months or even years. The use of Structum, Glucosamine, Chondroitin, Teraflex, Dona in therapy becomes an excellent prevention of relapses of arthrosis. Their active ingredients accumulate in tissues, providing a pronounced analgesic effect. Orthopedists gradually reduce the doses of NSAIDs, and then completely cancel these drugs.
Physiotherapeutic procedures
At any stage of arthrosis of the 1st metatarsophalangeal joint, electrophoresis is used. During the procedure, a bandage soaked in a drug solution (NSAID, chondroprotector, B vitamins, analgesic) is applied to the thumb. The doctor places a small metal plate on top of it. After weak electric current discharges pass through it, drug molecules penetrate into the joint cavity, providing a therapeutic effect. Electrophoresis is prescribed in combination with the following physiotherapeutic procedures:
- UHF therapy;
- magnetotherapy;
- laser therapy.
During these manipulations, blood circulation in the thumb is accelerated, metabolism is normalized, and regenerative processes are launched. In the treatment of arthrosis, applications with bischofite, paraffin, and ozokerite are used.
Traditional medicine recipes
Folk remedies are used in the treatment of metatarsophalangeal arthrosis to eliminate mild pain. They are able to cope with severe pain syndrome. To improve your well-being, you should take foot baths with essential oils of medicinal plants every day before bed:
- eucalyptus;
- fir;
- juniper;
- lemon balm;
- thyme;
- oregano;
- pine trees
Infusions of these plants also have a weak analgesic effect. They contain bioflavonoids, organic acids, phytoncides, tannins that accelerate blood circulation in tissues affected by arthrosis. To prepare the infusion, pour 2 tablespoons of dry plant material into a glass of boiling water, strain after a couple of hours and add to warm water. The time of the wellness procedure is 20-30 minutes. After drying, it is advisable to massage the feet with light stroking and kneading movements.
But tinctures for oral administration, rubs or homemade ointments will not help eliminate even the symptoms of arthrosis, and they are even less able to stop its progression. Treatment of degenerative pathology only with folk remedies will lead to the development of ankylosis and other severe complications. Orthopedists strongly advise that at the first problems with the foot, seek medical help and not use compresses made from plantain and cabbage leaves.
Stages of the disease
There are several classifications of arthrosis of the first metatarsophalangeal joint (Harttrup and Johnson, 1988; Barca, 1997; Easley, Davis et al., 1999, Coughlin MJ et al., 2003).
Depending on which of them is used, 3 or 4 stages of arthrosis are divided, not counting the pre-radiological stage (0).
First degree.
It manifests itself as periodic pain after excessive exertion, and rapid fatigue.
Second degree.
The pain syndrome is more pronounced. There is a limitation in dorsal flexion (extension) of the first finger. Radiographs reveal subchondral sclerosis, flattening of the articular surfaces, and narrowing of the joint space.
Third degree.
The pain becomes constant and bothers me even at rest. Dorsal flexion of the finger is absent, plantar flexion is limited. Joint deformity appears. Radiographs reveal bone growths and severe deformation of the articular surfaces.
Fourth degree.
All of the above symptoms become more pronounced, noticeable deformation appears, and the pain syndrome can become unbearable. In some cases, complete immobilization of the joint develops.
Diagnostics
An experienced diagnostician will suspect the development of metatarsophalangeal arthrosis during an external examination of the foot. Pathology is indicated by developing hallux valgus deformity, swelling of the big toe, and bowing of the foot when walking. To confirm the diagnosis, instrumental studies are performed. X-ray images show formed osteophytes, a decrease in the size of the joint space, and calcified areas. If necessary, a CT or MRI is prescribed. These methods are the most informative for detecting lesions of ligaments, muscles and tendons. Laboratory tests are also carried out:
- general blood and urine tests, the results of which will help assess the general health of a person;
- biochemical tests to confirm or exclude rheumatic lesions, endocrine disorders, metabolic disorders, including gout.
Examination of synovial fluid helps to establish the infectious origin of the inflammatory process. Based on its results, it is possible to determine the type of pathogenic bacteria and their sensitivity to antibacterial drugs.
Prevention of osteoarthritis
Preventive measures are intended to prevent the development of pathology. This is especially important in the presence of the first symptoms of arthrosis of the 1st metatarsophalangeal joint. This will prevent further progression in a timely manner.
One of the preventive measures for the disease is an active lifestyle.
So what to do:
- Walk barefoot more often in the summer on grass or sand. If this is not possible, use carpet in your home. But it is best to buy a carpet with long pile, as it gently massages the feet and joints.
- Strengthen the muscular system of your legs, especially your feet. To do this, do exercises daily. If you have a sedentary job, then in the process you can make movements with your legs, raising and lowering your heels.
- Walk up to your floor more often, because walking up the stairs strengthens not only the muscles of your calves, but also your feet. If you live in a private house, then make yourself improvised steps from books.
- Arthrosis can be prevented by daily massages of the fingers and feet in general. For example, before going to bed, after taking a bath, smear your limbs with your favorite cream and massage them.
- You can use cryotherapy, which means rubbing the joints with pieces of ice.
- Pay special attention to your diet. You need to consume antioxidants - vitamins E, C, A, selenium. They are found in large quantities in lemon and avocado, apricots and mangoes, spinach and parsley, carrots and broccoli, bell peppers and nuts. Avoid butter and animal fat, but give preference to vegetable oils.
- Gelatin consumption is important for joints and cartilage. Therefore, prepare jelly, aspic and jellied meat. It is advisable to make jelly at home from natural fruits, jams, compotes, since factory-made versions contain a lot of dyes and other additives that are harmful to the body.
- Do not abuse alcoholic beverages, strong coffee and tea.
- Watch your own weight - get rid of obesity, if you have it.
- Move more - this is the key to healthy joints.
- Wear only comfortable shoes and avoid shoes that are too tight. If you prefer heels, make sure to rest your feet periodically. Or give preference to a height of no more than 4 cm. Use orthopedic insoles.
Arthrosis of the metatarsophalangeal joint of the first toe can pose a threat of complications. Therefore, it is important to promptly focus attention on the symptoms that appear, the first of which is pain. After detecting signs, immediately contact a clinic where you will receive qualified assistance. And don’t forget to take care of your own joints by following preventive measures.
About arthrosis of the metatarsal joint
Most often, arthrosis of the metatarsal joint forms in the area of the main joint (big toe), affecting other joints. It is believed that arthrosis of the metatarsal joint is often preceded by anatomical changes such as flat feet, hallux valgus, and hammertoes. In men, arthrosis of the metatarsal joint is 4 times more common than in women , although bowed toes occur mainly in women.
Most complaints about arthrosis of the metatarsal joint are received between 30-35 years and then after 50 years. The main joint of the big toe consists of the rounded head of the first metatarsal bone and the base of the phalanx of the first toe. The main joint undergoes various changes: when walking, significant body load is distributed over it. A person constantly leans on the joint when walking, sometimes stretching it, which soon leads to mechanical wear of the cartilage. It is worth adding to this narrow dress shoes, which interfere with the movement of the fingers, impairing blood flow and slowing down metabolic processes in the tissues, causing the development of arthrosis of the metatarsal joint.
Playing football contributes to the appearance of arthrosis of the metatarsal joint. Despite the perfect sports shoes, when hitting the ball the joint experiences significant stress. It is worth not forgetting about the large number of injuries that professional football players can receive during the game. Such people are characterized by arthrosis not only of the small joints of the foot, but also of the ankle joint.