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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 HSS | Hospital for Special Surgery
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the eighth consecutive year) and No. 3 in rheumatology by U.S. News & World Report (2017-2018). Founded in 1863, the Hospital has one of the lowest infection rates in the country and was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. The global standard total knee replacement was developed at HSS in 1969. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State. In 2017 HSS provided care to 135,000 patients and performed more than 32,000 surgical procedures. People from all 50 U.S. states and 80 countries travelled to receive care at HSS. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. The HSS Global Innovation Institute was formed in 2016 to realize the potential of new drugs, therapeutics and devices. The culture of innovation is accelerating at HSS as 130 new idea submissions were made to the Global Innovation Institute in 2017 (almost 3x the submissions in 2015). The HSS Education Institute is the world’s leading provider of education on the topic on musculoskeletal health, with its online learning platform offering more than 600 courses to more than 21,000 medical professional members worldwide. Through HSS Global Ventures, the institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally.


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