I am often asked ‘what is the most common condition you see?’

To be honest it has to be plantar fasciitis, of which we have spoken about many times before. The second most common condition that graces Sussex Foot Centre is pain and swelling focal to the big toe joint. This joint is called the 1st, metatartoso-phalangeal joint. It sounds fancy but it isn’t! It’s the joint between the metatarsal and the phalanx, which put even simpler, is the toe. This joint takes a vast amount of load and if the foot is functioning properly can take three times our body weight through the joint.

There are many reasons why patients get pain and swelling on the big toe joint but many of them are still theories. These theories are heavily disputed and argued within the literature with no-one taking a prominent position.

The picture below shows the long bone as the 1st metatarsal and the phalanx, with a ‘black blob’ in the middle, this blackness is swelling and therefore inflammatory fluid. It is this that comes as a result of overload to the joint. In this example, the joint became overloaded as a result of the patient training for the London marathon.

Ultrasound showing selling on the big toe joint
Ultrasound showing selling on the big toe joint

But how do we treat it?

The best way to treat this condition is a good orthotic, in a good shoe. The idea is to take pressure away from the joint, this will be tried for a good few weeks. Should this fail, then a small injection of cortisone works very well.

I’ll keep you posted with how this Patient’s treatment continues…

If you have any questions or would like to book an appointment, get in touch with us on 01444 453874 or on our contact page!

Jonathan Collins Specialist Podiatrist
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