Big Toe Problems

Did you know the most common site of osteoarthritis in the human body besides the knee, is the great toe joint? Bunions are a common cause of great toe joint pain, but so is plain old arthritis (hallux limitus/rigidus). The great toe joint also happens to be the most common site for gout to attack. Recurrent gout attacks can cause painful arthritis to the joint as well. If you have pain and want an opinion please see the Ask Dr. Adams page.

Did you know – Most surgeons do not have additional Fellowship training?

Fellowships are not a requirement for surgeons following the completion of a surgical residency. They are completed to allow the mastery of particular procedures, and provide top notch care.

Dr. Adams is one of the few surgeons in the state of Indiana that completed a Foot and Ankle Fellowship that specifically researched treating failed great toe joint replacement surgery with autograft.

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If you have a chronic toe pain, and have questions or concerns, please feel free to call Doctor Adams at (317) 477-6683 or schedule a consultation online.

Learn more about Dr. Adams

Dr. Adams is a born and raised Hoosier. He attended Indiana University-Bloomington where he met his wife Allison. He got degrees in Nutrition Science, Biology and Chemistry. Dr. Adams then got his doctorate from Kent State College of Podiatric Medicine where he was a Dean’s List student. He then came back to Indianapolis to do his residency surgical training and was Chief resident. He stayed in Indianapolis and completed a specialty Fellowship focusing on Adult and Pediatric Reconstruction. During his Fellowship Dr. Adams helped launch the first foot and ankle dedicated surgical practice at Hancock Orthopedics, and has been employed there since.

Dr. Adams enjoys teaching as he helps educate and train the surgical residents at Community Health Network, and the Fellows at American Health Network. He actively participates in research and editing for national peer reviewed journals.

He is also a consultant for orthopedic device companies where he is afforded the opportunity to help train and design with other surgeons across the country.

Dr. Adams has special interests in the following areas:

Arthroscopic joint surgery

Minimally invasive calcaneal fracture repair

Flat foot reconstruction, adult and pediatric

Vitamin D and its correlation with bone healing

Cartilage restoration for the ankle joint

Regenerative medicine

5th Metatarsal fractures

Non-union revision surgery

Dr. Adams is a father of two and resides with his family in Fishers. He enjoys the short commute to Hancock Health in Greenfield.

William J.E. Adams, DPM CV (pdf)

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Bunion Deformity

No – shoes do not usually cause bony deformities. They can aggravate a pre-existing condition, but a bunion, or hallux abducto valgus deformity is inherited. Usually you will find family members with a foot that is very similar to yours!

Generally yes, but not typically quickly – bunion deformities are an issue with bony alignment. Because the joint is aligned improperly the great toe joint over time will wear out due to the joint not gliding in good orientation/alignment. This eventually causes premature arthritis and eventual progression of the muscle tendon imbalance and joint capsule issues that coincide.

It truly depends on each person. Everyone perceives pain differently. On average it is not the most painful procedure, or difficult recovery there is considering the broad variety of procedures foot and ankle surgeons do.

It depends on how you and the surgeon decide to fix your bunion. The most common methods are realignment osteotomies, great toe joint fusions, and the tarsometatarsal fusion (Lapidus). Each of these procedures recoveries are slightly different. On average most people are walking in a boot by 1-2 weeks. Potentially driving around then, and ideally back in a sneaker around 4-8 weeks contingent upon procedure selection. The Lapidus procedure has a longer recovery that involves a 2-4 week period of non-weight bearing, and more conservative recovery.

The great toe joint fusion, or 1st MTP Arthrodesis, affords the most reliable position of the great toe (straightening), and the most durable outcome. This procedure is not for everyone, but is and has been a gold standard for years when fixing bunions and great toe arthritis (hallux rigidus.

Absolutely – unfortunately juvenile hallux abducto valgus deformities are not rare, although not common. They can cause pain, and sometimes need to be surgically corrected in adolescence.

Not necessarily – it depends on the surgical technique required. This will be determined between the parent , child, and surgeon.

No – foot surgery is always a serious consideration, and we do not recommend prophylactic, or aesthetic bunion surgery.

Yes! Although more common in women, men also develop painful bunion deformities.

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Before & After Photos of Toe Problems

*Your results will vary

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Hallux Varus

Yes – the big toe drifts the opposite direction as it does with a bunion. It is most commonly a result of a previously overcorrected bunion surgery.

Typically no – usually the abductor hallucis muscle needs to be released, or the joint needs to be fused to correct the issue. There are other options your surgeon will discuss, but these are two of the most common methods of correction.

Are you an Indianapolis resident seeking a foot & ankle surgeon?

Dr. Wil Adams is close and worth the short drive.

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Sesamoid Pathology

There are two small bones that live under the great toe joint. They are the same type of floating bone your kneecap or patella is. The alter the pull of the muscle tendon that glides over them. They have cartilage on them so they can glide underneath the metatarsal head during gait. These bones at times can become very painful due to a variety of issues. Generally when these small bones are inflamed it is referred to as sesamoiditis.

Sesamoiditis can be a very painful condition at times. It is often seen in people with extra force being repetitively applied (runners, ballet dancers, etc) to the great toe joint. When these bones and the joint they make up become inflamed they often need aggressive conservative therapy such as anti-inflammatories (oral and injected), RICE therapy, a short walking boot, and orthotics. It is rare this becomes a surgical issue. See cavus feet for more discussion on when it can become a chronic issue.

Arthritis – yes, believe it or not, because these bones have cartilage on their surface that glides underneath the metatarsal head they can become painful due to cartilage loss and arthritis. When they become degenerative enough and conservative care fails, occasionally we will recommend a great toe joint fusion. This is only recommended in instances when patients have failed all other options. It’s important to know this is a definitive treatment option that reliably does provide resolution of symptoms. Isolated sesamoid removal is often an unpredictable, poor outcome surgery – long term. Removing these bones drastically alters the functionality of the great toe joint in a bad way.

Sesamoid fractures from trauma and stress happen occasionally too. These fractures are painful and can take a long time to heal 2-4 months. However they typically will get better in time and surgery is generally not recommended.

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Stiff Big Toe Joint (Hallux Rigidus)

Great toe joint arthritis – or in medical terminology known as Hallux Rigidus/Limitus, is an extremely common condition. In fact, one of the most common places in the human body to develop wear and tear arthritis (osteoarthritis) besides the knee, is the great toe joint. When the cartilage in the joint gets thin, and continued jamming occurs, this encourages bone growth around the margins of the joint to form causing painful spurs that can enlarge the joint and rub in shoe gear. Patients often notice a bump they mistakenly refer to as a bunion. This great toe joint issue is different from a bunion in that it does not typically involve an angular deformity.

Steroid injections, custom inserts, topical pain creams/ anti-inflammatories and wide shoes.

What type of surgery is recommended to address Hallux rigidus/limitus?

A cheilectomy vs a great toe joint fusion vs a decompression type osteotomy. The cheilectomy is basically a joint clean where spurs and loose bone is removed and the joint is narrowed to create better motion. This procedure typically does not last more than 5-7 years. A decompression osteotomy is when the metatarsal is cut, and shortened to create more joint space. This increases motion and helps increase joint longevity. It also does not typically last more than 10 years. Spurs are also removed during this procedure. Lastly, the great toe joint arthrodesis is the gold standard. It fuses the joint in anatomic position by removing cartilage from the joint and fixating the toe to the metatarsal. This procedure lasts forever and if performed appropriately works very well and usually offers high satisfaction. The major con is it eliminates all motion through the joint.

Less discussed and preferred by many surgeons is the great toe joint replacement . The procedure is less predictable and requires major bone resection/removal. If the implant is placed in a patient that is too young, it can cause premature failure, necessitating removal and conversion to a fusion. This requires substantial bone grafting and recovery. This procedure is generally only recommended for people that are 6th-7th decade of life and older, and not extremely active.

Cartiva is a hemi-arthroplasty implant that gained a lot of popularity due to initially what appeared as promising results. Unfortunately as the procedure was performed very regularly across the country for the past few years, there have also been a high number of reported failures; see here. In cases where pain has not improved, patients have unfortunately had to undergo bone block fusion procedures to fill the void the implant leaves after removal. The fusion is the ideal revision procedure as the outcome provides a durable and predictable outcome assuming the fusion site heals ideally.