Foot Health: A bunion or arthritis? Women often get the painful conditions confused

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By Dr. Sarah Voelkel
KyForward columnist
 

Women – are you confusing a bunion with arthritis?
 

No woman wants to hear that she has arthritis, especially in her feet.  But with the average person taking thousands of steps each day, it’s no wonder arthritis affects us. 
 

Unfortunately, some women confuse what they think is pain from a bunion with arthritis in the big toe joint. This condition is called Hallux limitus and most commonly affects females. We usually see its onset in a patient’s 30s, and it progresses over time.
 

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Hallux rigidus (Photo from Wikimedia Commons)

The reason women may confuse Hallux limitus with a bunion is the fact that this condition also causes a bump and enlargement at your big toe joint that may appear similar to a bunion. As the condition progresses, more degenerative changes to the joint occur. More spurs develop, the range of motion gradually decreases and the joint can become very stiff. When the pain increases and the function decreases, we then refer to this as Hallux rigidus
 

How do you get arthritis in your feet?
 

Arthritis in the big toe joint can be hereditary but also due to structural abnormalities of the foot.  Most patients notice a gradual enlargement of the big toe joint with bumps on the top and side of the joint.  However, many times it’s only with increased exercise or activity levels that they may notice increased pain, achiness and sometimes swelling of the joint. 
 

The condition can easily be diagnosed in a physical exam by your podiatrist and with X-rays of the foot.  The X-rays are needed to determine the extent of the issue and help guide treatment.
 

How do you treat it?
 

Non-surgical: Hallux limitus is initially treated conservatively.  Depending on your pain level you may need steroid injections to decrease inflammation in the area, oral anti-inflammatory medication or ice/heat therapy.  Changing shoe gear is important as well as adding custom orthotic devices to your shoes to help offload the stress at the big toe joint.
 

If the condition continues to progress, causing pain and decreased function, despite the conservative treatment, surgery is then recommended.  The severity of the condition at that time will determine which surgical procedure to do. 
 

For more minor conditions we can perform a cheilectomy where the spurs are resected from the joint area.  This can help improve the joint motion and decrease pain.  It is known as a joint-salvaging procedure so the joint is preserved.
 

For more advanced conditions where the joint is significantly degenerated, the joint-salvaging procedures are not the best option.  We then need to look at replacing or fusing the joint surfaces. 
 

Depending on your foot structure and the level of joint involvement you may be a candidate for joint replacement where one or both surfaces are replaced with a joint implant.  This allows for continued joint range of motion, decreased effect on activity level and improved patient satisfaction. 
 

There are risks of the implant loosening or failing over time, possibly requiring future surgical revision. 
 

If you are not a candidate for joint replacement, the next option is joint fusion.  This is done by removing the damaged cartilage and fixating the area with screws and possibly a plate.  This is a permanent correction of the condition with elimination of the arthritis and improved pain. 
 

Most patients do very well with this despite having a fused joint and most are able to resume some type of physical activity.  Recovery from surgery is quicker for the cheilectomy and joint implant-approximately four to six weeks, but a little longer for the fusion so as to allow adequate time for the bones to fuse-up to eight to 10 weeks. 
 

Again, conservative treatment is the best option, but if left unchecked, surgery may be the only option left. If you are unsure if you have arthritis in your feet, contact your podiatrist and have a full examination.
 

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Dr. Sarah Voelkel is a foot and ankle surgeon at Lexington Podiatry and the Kentucky Heel Pain Center.
 

For more Foot Health columns, click here.
 
 
 
 
 
 

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