Abstract
The toe joint is susceptible to the development of arthritis from various conditions that can damage the joint cartilage. Osteoarthritis is the most common form of arthritis that results in toe joint pain; rheumatoid arthritis and posttraumatic arthritis are also frequent causes of toe pain. Less common causes include the collagen vascular diseases, infection, and Lyme disease. Acute infectious arthritis is usually accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized; it is treated with culture and antibiotics rather than injection therapy. Collagen vascular disease generally manifests as polyarthropathy rather than as monarthropathy limited to the toe joint, although toe pain secondary to collagen vascular disease responds exceedingly well to the intraarticular injection technique described later. Gout often affects the first interphalangeal joint of the foot and the clinical syndrome is known as podogra.
Keywords
foot pain, toe pain, arthritis, osteoarthritis, rheumatoid arthritis, infectious arthritis, joint mouse, synovitis, ultrasound guided injection, diagnostic sonography, Charcot joint
ICD-10 CODE M19.90
Keywords
foot pain, toe pain, arthritis, osteoarthritis, rheumatoid arthritis, infectious arthritis, joint mouse, synovitis, ultrasound guided injection, diagnostic sonography, Charcot joint
ICD-10 CODE M19.90
The Clinical Syndrome
The toe joint is susceptible to the development of arthritis from various conditions that can damage the joint cartilage. Osteoarthritis is the most common form of arthritis that results in toe joint pain; rheumatoid arthritis and posttraumatic arthritis are also frequent causes of toe pain. Less common causes include the collagen vascular diseases, infection, and Lyme disease. Acute infectious arthritis is usually accompanied by significant systemic symptoms, including fever and malaise, and should be easily recognized; it is treated with culture and antibiotics rather than injection therapy. Collagen vascular disease generally manifests as polyarthropathy rather than as monarthropathy limited to the toe joint, although toe pain secondary to collagen vascular disease responds exceedingly well to the intraarticular injection technique described later. Gout often affects the first interphalangeal joint of the foot and the clinical syndrome is known as podogra ( Fig. 128.1 ).
Signs and Symptoms
Most patients present with pain localized to the affected joint of the foot, most commonly the great toe. Activity, especially flexion of the toe joints, makes the pain worse ( Fig. 128.2 ), whereas rest and heat provide some relief. The pain is constant and is characterized as aching; it may interfere with sleep. Some patients complain of a grating or popping sensation with use of the joint, and crepitus may be present on physical examination. In addition to pain, patients often experience a gradual decrease in functional ability because of reduced toe range of motion that makes simple everyday tasks such as walking, standing on tiptoes, and climbing stairs quite difficult.
Testing
Plain radiographs are indicated in all patients who present with toe joint pain ( Figs. 128.3, 128.4, and 128.5 ). Magnetic resonance imaging and ultrasound imaging of the toe are indicated if joint instability, an occult mass, or a tumor is suspected ( Figs. 128.6 and 128.7 ). Based on the patient’s clinical presentation, additional testing may be warranted, including a complete blood count, erythrocyte sedimentation rate, and antinuclear antibody testing.
