Dr. Peter J. Bregman, DPM
Top Rated Podiatrist in Las Vegas
This is arthritis of the big toe joint (metatarsal phalangeal joint) which is graded by it’s severity.
This is arthritis of the big toe joint (metatarsal phalangeal joint) which is graded by it’s severity:
Mild arthritis with inflammation, swelling and some pain which is usually not constant.
Moderate arthritis with a limitation in the range of motion of the big toe joint and aggravated with activity and high heels. X-rays will show spurring and some loss of joint space. Sesamoids can be affected.
Severe arthritis with almost complete loss or total loss of joint space on x-ray and constant pain. Sesamoids are almost always involved.
NSAIDS, Rx Topical Medication, Laser, ICE and Orthotic management
Same as Stage 1 but if fails may consider injection of Amniotic fluid (insurance usually won’t cover this) Surgery in the form of a cheilectomy, which is a removal of the arthritis/spurs by removing it with surgical equipment. Not always definitive. Also may consider an osteotomy of the metatarsal or phalanx depending upon the structure of the foot. Cartiva implant ( the latest technology) Dr. Bregman has placed the most of these in Nevada.
Can try amniotic fluid injection but this will not cure it, may last for 6 months to a year. Can inject over and over if you like this treatment. Most often this will be treated with an implant of some kind. Dr. Bregman has tried a variety if implants and currently is advocating the Cartiva implant as long as there is no sesamoid involvement, if there is he recommends a total implant either silicone or metal composite. Arthrosurface is used often.
Fusion or Implant
Post Operative courses for above surgical options:
48 hours stay off foot and elevate and ice. PT. Dynasplint (medical device to wear at home covered by insurance) Then wear boot for 2-3 weeks, then back in sneakers till 6 weeks or so then regular shoes to tolerance.. Topical pain meds. * Cartiva can take up to 8 months to reach maximum medical improvement.
Osteotomy with or without implant
Stay off for 48 hours completely, elevate and ice. Wear cam walker boot for 4-6 weeks. Physical therapy. Topical pain medication, cold laser therapy. Back in regular shoes around 8- 10 weeks. Return to full activity around 3-4 months depending on activity level. Can swim or do stationary bike after 4-6 weeks