Arthritis Pain of the Toes

THE CLINICAL SYNDROME

The toe joint is susceptible to the development of arthritis from a variety of conditions that have in common the ability to damage the joint cartilage. Osteoarthritis of the joint is the most common form of arthritis that results in toe joint pain. However, rheumatoid arthritis and post-traumatic arthritis are also common causes of toe pain include the collagen vascular diseases, infection, and Lyme disease. Acute infectious arthritis will usually be accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized by the astute clinician and treated appropriately with culture and antibiotics rather than with injection therapy. The collagen vascular diseases will generally present as a polyarthropathy rather than a monarthropathy limited to the toe joint, although toe pain secondary to collagen vascular disease responds exceedingly well to the intra-articular injection technique described here.

SIGNS AND SYMPTOMS

The majority of patients presenting with toe joint pain secondary to osteoarthritis and post-traumatic arthritis pain will present with the complaint of pain that is localized to the affected joint of the foot. The great toe is most commonly affected. Activity, especially flexion of the toe joints, makes the pain worse, with rest and heat providing some relief. The pain is constant and characterized as aching in nature. The pain may interfere with sleep. Some patients will complain of a grating or popping sensation with use of the joint and crepitus may be present on physical examination. In addition to the pain, patients suffering from arthritis of the toe joint will often experience a gradual decrease in functional ability with decreasing toe range of motion, making simple everyday tasks such as walking, standing, on tiptoes, and climbing stairs quite difficult.

Arthritis affecting the joints of the toe will often present as pain made worse with weight-bearing activity.

Treatment

Initial treatment of the pain and functional disability associated with arthritis of the toes should include a combination of the nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors and physical therapy. The local application of heat and cold may also be beneficial. Avoidance of repetitive activities that aggravate the patient’s symptomatology, as well as short-term immobilization of the joints of the toes, may also provide relief. For patients who do not respond to these treatment modalities, an intra-articular injection of the affected joints with local anesthetic and steroid may be a reasonable next step.

Coexistent bursitis and tendinitis may also contribute to arthritis pain of the toes and may require additional treatment with more localized injection of local anesthetic and methylprednisolone acetate. The injection technique is extremely effective in the treatment of pain secondary to the aforementioned causes of arthritis of the joints of the toes. This technique is a safe procedure if careful attention is paid to the clinically relevant anatomy in the areas to be injected. The use of physical modalities including local heat as well as gentle range of motion exercises should be introduced several days after the patient undergoes this injection technique for arthritis pain. Vigorous exercises should be avoided because they will exacerbate the patient’s symptomatology.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue. Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.