Osteoarthritis can occur in any joint, when it occurs at the base of the big toe, or metatarsophalangeal joint, it is called hallux rigidus, or stiff big toe. Osteoarthritis is a degenerative joint disease that develops after years of use. When the smooth cartilage that covers the ends of the bones wears down, it leads to joint pain, stiffness, and swelling. When the bones begin to grind on each other, it can result in constant pain during standing or walking, and loss of mobility.

Symptoms

Hallux rigidus symptoms can include one or more of the following:

• Pain in the joint
• Increased pain with movement, especially when pushing off the big toe
• Swelling
• Difficulty walking
• Bump develops on top of the foot
• Inability to bend the big toe up or down

Diagnosis

Your orthopedic surgeon will examine your foot for swelling, evidence of bone spurs, and test your range of motion. X-rays are taken to provide a detailed picture of your foot to show the level of cartilage degeneration and the size and location of any bone spurs.

Non-surgical treatment

There is no cure for arthritis, but treatments are designed to relieve pain and restore motion. Non-steroidal anti-inflammatories (NSAIDS) and ice can help relieve swelling and help reduce inflammation in the early stages of hallux rigidus. Lifestyle modifications such as wearing a shoe with a larger toe box and getting a stiff soled shoe with a rocker bottom design to reduce motion in the toe joint can also help relieve pain. Corticosteroid injections can also be effective in reducing inflammation and pain.

Surgical treatment options

Fusing the bones together (arthrodesis) is a very reliable treatment to relieve toe pain when the cartilage loss is severe and walking becomes difficult. In this surgical procedure, the bones of the big toe are attached with a plate and screws. In most people the operation is very successful and pain relief is achieved. However, your toes are designed for movement and the range of motion becomes limited. The recovery from this procedure requires a cast for six weeks, followed by using crutches for another six weeks.

When the damage is not as severe, chielectomy (kI-lek’-toe-me) may be recommended. This surgical procedure involves removing the bone spurs and a portion of the foot bone to make more room for the toe to flex. After surgery, the patient will wear a hard-soled sandal for at least two weeks. The toe and incision may remain swollen for several months after the operation.

A newer treatment option is using an implant called Cartiva. In this procedure, the orthopedic surgeon makes a small incision on the top of the toe and removes damaged bone in the toe joint. The gel-like implant is placed into a small hole in the bone and secured with cement or glue. The implant is made of a smooth organic polymer (plastic) that functions similar to cartilage. It provides a smooth, slippery, weight-bearing surface for the joint. Immediately following surgery, your foot will begin bearing weight in order to regain range of motion. The recovery from the implant procedure requires the patient to wear a soft boot for 2-3 weeks. Patients can begin to resume normal activities 5-6 weeks after surgery in normal footwear.

Each treatment option has risks and benefits that you should discuss with your doctor if you have this condition.

What's a bunion?

A bunion is a painful, bony bump that develops on the inside of the foot at the big toe joint. Bunions may also be referred to as hallux valgus. Bunions begin to form when the big toe joint is forced out of alignment.

Causes and risk factors

• Wearing narrow shoes, forcing toes into an unnatural position
• Heredity
• Inflammatory condition such as rheumatoid arthritis
• Neuromuscular condition such as polio

Symptoms

• Visible bump on the inside of the foot
• Callus or corn on the bump
• Pain and tenderness in the joint area
• Redness and inflammation
• Stiffness and restricted motion in the big toe
• Difficulty walking

Diagnosis and treatment

In most cases bunions are treated without surgery. Nonsurgical treatment of bunions cannot remove the bump but can reduce pain and keep symptoms from worsening. Changes in footwear and added padding to current shoes can help alleviate symptoms and take pressure off the bunion. Ice and nonsteroidal anti-inflammatory medications may also help. If pain continues over time despite changes in footwear, your orthopedic surgeon may discuss surgery to realign the bone, ligaments, tendons, and nerves and put the toe back in correct position.

An ankle sprain happens when the ligaments that support the ankle are forced to stretch beyond their limit. This is a fairly common injury that occurs among people of all ages. They range from mild to severe, depending upon how much damage occurs.

Causes and risk factors

• Running, walking, or cross training on an uneven surface
• Falling and twisting the ankle
• Sports that require cutting actions, creating the ability to roll the foot

Symptoms

• Swelling in the ankle and foot area
• Bruising in the area surrounding affected ankle
• Tenderness to the touch
• Weakness and instability of the ankle joint

Diagnosis and treatment

The majority of all ankle sprains will heal without the need for surgery. Even a complete ligament tear will heal naturally if given the appropriate rest. Rest and protection of the ankle are the initial recommendations for a sprained ankle. Once swelling is reduced, range of motion, strength, and flexibility will be reintroduced through various exercises dictated by your orthopedic specialist.

What happens when you fracture your ankle?

There are three bones that make up the ankle joint: the tibia, fibula and talus. A broken ankle, or fracture, occurs when one or more of these bones break. The joints and ligaments that make up the ankle can also be damaged when a fracture occurs. Common causes include impact during sports or car collision, tripping or falling, and rolling your ankle.

Symptoms

The symptoms of a fractured ankle are similar to an ankle sprain, so you should be evaluated by an orthopedic surgeon after an injury.

• Immediate pain
• Swelling and bruising
• Can’t bear weight on the injured foot

You may not require surgery if the ankle remains stable and the fracture is minor. If the fracture is out of place or your ankle is unstable, your orthopedic surgeon may need to do surgery. Watch this short video to see the surgical procedure used to correct a fracture of the fibula or tibia in the ankle joint.

Where is the ulnar collateral ligament?

On both sides of the elbow, thick ligaments hold the joint together. The ligament that connects the humerus and the ulna on the inside of the elbow is called the ulnar collateral ligament (UCL). Damage, inflammation, or a tear of the UCL is a common injury for baseball pitchers and other athletes who play throwing sports.

Causes and risk factors

This ligament is rarely stressed in daily activities, it is usually injured from overuse. Repeated overhead throwing can stretch or tear the UCL ligament.

Symptoms

• Pain on the inside of the elbow, especially when throwing
• A pop or tearing sensation at the time of injury
• Decreased throwing velocity
• Inability to straighten the elbow
• Numbness or tingling in ring and pinky finger

Diagnosis and treatment

Nonsurgical treatment of an ulnar collateral ligament injury includes rest, ice, non-steroidal anti-inflammatory medications, and physical therapy. If these treatments do not relieve symptoms, surgery may be necessary to reconstruct the UCL ligament. This procedure is commonly referred to as “Tommy John surgery”, named after the former major league pitcher who first had the surgery done in 1974.

What is Tennis Elbow?

Tennis elbow, or lateral epicondylitis, is an inflammation of the tendons that join the forearm muscles on the outside of the elbow. Racket sports like tennis and pickleball tend to be a major cause for this injury and elbow pain, but any heavy use of the elbow with repetitive gripping and lifting can be a cause of this condition. It is a common work-related injury for plumbers, painters, carpenters, mechanics, and butchers. Generally, lateral epicondylitis develops gradually, but at times can occur acutely from an injury.

Causes

• Extended use in activity: Engaging in repetitive activities that involve the forearm muscles, such as gripping, twisting, or lifting, for an extended period can contribute to tennis elbow. These activities can strain the tendons in the elbow, leading to inflammation and pain.
• Wear and tear of overuse: Overuse of the forearm muscles without adequate rest and recovery can lead to wear and tear of the tendons, causing tennis elbow. This can occur in various occupations or recreational activities that involve repetitive motions, such as painting, plumbing, or playing musical instruments.
• Improper equipment in sports like tennis: In sports like tennis, using improper equipment or techniques can increase the risk of developing tennis elbow. For example, using a racquet with an ill-fitted grip size or playing with a technique that places excessive strain on the forearm muscles can contribute to the condition.

Risk factors

• History of rheumatoid arthritis: Rheumatoid arthritis is an autoimmune condition that causes inflammation and damage to joints, including the elbow. Individuals with a history of rheumatoid arthritis may be at an increased risk of developing tennis elbow.
• History of nerve disease: Certain nerve diseases or conditions can affect the function and health of the nerves in the forearm and elbow. These conditions may increase the likelihood of developing tennis elbow.
• Dominant arm primarily affected: Tennis elbow commonly affects the dominant arm, which is the arm predominantly used for activities and sports. The repetitive motions and overuse of the forearm muscles in the dominant arm can contribute to the development of tennis elbow.

Symptoms

• Tenderness in the outer elbow: One of the main symptoms of tennis elbow is tenderness or pain located on the outside of the elbow. This tenderness is often localized to the bony prominence called the lateral epicondyle.
• Burning sensation in the elbow: Some individuals with tennis elbow may experience a burning sensation in the affected elbow. This sensation can be present at rest or during activities involving the forearm muscles.
• Pain and weakness when using the affected elbow: Tennis elbow can cause pain and weakness in the elbow, particularly when performing activities that involve gripping, lifting, or twisting motions. Everyday tasks like shaking hands, turning a doorknob, or gripping a tool can become painful and challenging.
• Pain with resistance: When pressure or resistance is applied to the wrist or forearm muscles, individuals with tennis elbow may experience increased pain. This can be observed when attempting to lift or carry objects or when performing activities that require forearm muscle contraction against resistance.
• Pain and weakness with gripping/lifting: Tennis elbow can make gripping and lifting objects difficult and painful. Even simple tasks like holding a coffee cup, lifting a book, or carrying groceries may elicit discomfort and weakness.

Diagnosis and treatment

Several factors are considered by the doctors when making the diagnosis, including history of related injury, use, and health. Tests such as x-ray may be utilized to rule out other possible causes for elbow pain, such as arthritis or a fracture. The majority of tennis elbow treatment is done without surgery.

Nonsurgical treatment options include:

• Short period of rest
• Keep your elbow moving to prevent stiffness
• Avoid aggravating activities such as lifting/forceful gripping
• Short term nonsteroidal anti-inflammatories (NSAIDs)
• Massage to painful area to increase blood flow and desensitize
• Stretching exercises to maintain flexibility of the elbow and wrist
• Topical anti-inflammatory/pain relief creams
• Compressive elbow wrap
• Wrist brace
• Acupuncture
• Physical therapy

The vast majority of cases will resolve with this type of treatment, but symptoms may last for 6 – 12 months or longer.

What is Golfer's Elbow?

Also known as medial epicondylitis, golfer’s elbow occurs when the tendons that attach the forearm muscles to the inside of the bone at the elbow become inflamed. Similar to tennis elbow, this inflammation occurs with repetitive motion and overuse.

Causes and risk factors

• Repetition of movement
• Overuse of the muscle
• Weakness of the area
• Hurried golf swing

Symptoms

• Tenderness
• Swelling
• Muscle spasm
• Muscle weakness
• Inflammation
• Cramping

Diagnosis and treatment

Most cases of golfer’s elbow can be treated without surgery with rest, ice, compression, and elevation. In addition, consider modifying your grip and/or the use of a larger grip, if your symptoms are stemming from a racquet sport or golf. If your symptoms do not respond after six to twelve months of nonsurgical golfer’s elbow treatments, your doctor may recommend surgery.

Nonsurgical treatment options include:

• Short period of rest
• Keep your elbow moving to prevent stiffness
• Avoid aggravating activities such as lifting/forceful gripping
• Short term nonsteroidal anti-inflammatories (NSAIDs)
• Massage to painful area to increase blood flow and desensitize
• Stretching exercises to maintain flexibility of the elbow and wrist
• Topical anti-inflammatory/pain relief creams
• Compressive elbow wrap
• Wrist brace
• Acupuncture
• Physical therapy

The vast majority of cases will resolve with this type of treatment, but symptoms may last for 6 – 12 months or longer.

The biceps muscle is the large muscle in the front of your arm that help to flex your elbow and rotate your forearm. The distal biceps tendon is the tendon that connects the biceps muscle to your forearm. This tendon is a common source of pain and injury. In most cases, pain in the distal biceps tendon is related to overuse and tendonitis. At times, however; the tendon may tear either partially or completely. Biceps tendonitis/tears are most common in men aged 30 – 60, but may occur at any age and either sex.

Causes and risk factors

• Repetitive lifting/forearm rotation
• Overuse from work/sports
• Traumatic injury from the elbow forcefully extending against weight

Symptoms

• Pain, swelling, tenderness in the anterior forearm/elbow
• Weakness/pain with elbow flexion and/or forearm rotation
• In acute injuries, patient will often hear/feel a “pop” and develop significant bruising in along the elbow and forearm

Diagnosis and treatment

In many cases, the diagnosis is based on your history, symptoms, and exam. Plain radiographs (x-rays) may be obtained. If there is concern for a tear of the biceps, then an MRI of the elbow will often be ordered. Treatment depends on the extent of injury to the distal biceps tendon.  Tendonitis and partial tears are generally treated nonsurgically.

Nonsurgical treatment include rest, ice, nonsteroidal anti-inflammatory drugs (NSAIDS), and physical therapy. Activity modification is key, including avoiding aggravating activities. Most patients with tendonitis and/or partial tearing of the biceps can expect recovery and return to normal activity with non-surgical treatment. If conservative treatment options do not relieve your pain, your orthopedic surgeon may discuss surgery.

A complete tear of your distal biceps tendon can be treated either surgically or nonsurgically.  Your orthopedic surgeon should discuss options and relative advantages and disadvantages of both treatment options. With nonsurgical treatment, most experience some loss of strength but overall good function. Surgical treatment can maximize strength and function. It entails reinserting the torn tendon to its normal attachment on one of your forearm bones.

Did you dislocate your elbow?

Elbow dislocation is an uncommon injury for most. The injury most often occurs during a fall with an outstretched arm/hand taking much of the force of the fall, sending that force through the arm to the elbow joint. There are several different types of dislocations, such as simple, complex, and severe, wherein blood vessels and nerves in the joint area may be damaged as well.

Causes and risk factors

• Loose ligaments
• Shallow grooved ulna bone
• Medical history
• Fall onto hand with outstretched arm

Symptoms

• Pain in the arm
• Deformed looking arm
• Awkward twist in the arm at elbow
• Bruising
• Swelling
• Numbness

Diagnosis and treatment

Depending on the severity of the dislocated elbow, this may at times be treated as an emergency and hospital attention may be needed. Simple dislocations can be treated by keeping the elbow immobile with a sling or a splint followed by physical therapy to aide in recovery. For more complex injuries surgery may be necessary – especially if elbow bone fractures and ligament repairs are needed as well.

What is cubital tunnel syndrome?

Cubital tunnel syndrome, or ulnar neuritis, is inflammation of the ulnar nerve in the arm that results in numbness or weakness in the hand. The ulnar nerve is more commonly knows as the “funny bone” and gives feeling to the little finger and half of the ring finger. It also controls most of the little muscles in the hand that help with fine movements and some of the bigger muscles in the forearm that help you make a strong grip. Left untreated, long term cubital tunnel syndrome can lead to severe weakness and disability in the hand.

Causes and risk factors

• Constant pressure on ulnar nerve at the elbow or wrist
• Extensive leaning on the elbow
• A surplus of fluid in the elbow
• Direct force on the inside of the elbow
• Arthritis of the elbow
• Past fracture or dislocation of elbow joint

Symptoms

• Tingling and numbness in fingers
• Ring and little finger “falling asleep”
• Lack of strength in grip and finger coordination

Diagnosis and treatment

If the nerve is compressed for a long time, irreversible muscle atrophy in the hand can occur. It’s important to see your doctor if elbow nerve pain symptoms are present for more than six weeks or are severe. The majority of treatments for ulnar nerve pain relief are nonsurgical such as anti-inflammatory medicines, splinting, or bracing the arm or nerve exercises to prevent stiffness. If symptoms do not subside, there are surgical treatments such as cubital tunnel release and ulnar nerve anterior transposition that an orthopedic doctor may discuss with you.