It is informally called "Big Toe Arthritis." A new implant made out of contact lens material may provide you some relief.
Patient Elizabeth Carbonell explains, "I knew that I needed surgery to the point that I was limping."
Carbonell has suffered from foot pain for years. She blames her love of high heels her entire adult life.
"I guess I was very vain when I was younger and I was always in high heels, to the point I would go to school in high heels, go to university in high heels, go to work in high heels," she says.
However, a few years ago, the pain in Carbonell's feet and the rest of her body became unbearable.
"That type of walking hinders you in other ways because it causes lower back problems," Carbonell says, wincing at the memory of her pain. "That's one of the biggest red flags in my case when you realize that you have such terrible pain in your lower back. And it's all due to your feet and the way you're walking."
Carbonell ended up opting for surgery on her left big toe. But it only led to more problems and three surgeries. Even now, years later, she says it is painful. Her ability to move the toe is compromised.
"It was a complete disaster."
Still in pain, limping and somewhat traumatized by how wrong things went in that last surgery where her toe joint fused and was made unmovable, Carbonell waited for just the right option for her other foot.
"The whole idea of having to re-do something like that again was just horrible in my mind," she says.
"When we talk about big toe arthritis, we're talking about this area here," says Carbonell's orthopedic surgeon says as he points to the bone of the big toe on a skeletal model.
Doctor Amiethab Aiyer with the University of Miami's Health System is using the new Cartiva implant in surgeries for big toe arthritis.
Still pointing at the first joint of the big toe, Doctor Aiyer explains, "It's this area here where my finger is that is particularly affected by this. That's when we really start talking to the patients about adjusting shoe wear."
If that fails, the talks switch to surgery.
About two million people across the U.S. have ‘big toe arthritis", most of them women. Dr. Aiyer says you get big toe arthritis a couple of different ways, with varying degrees of severity and pain.
Inflammation from rheumatoid arthritis, gout, a fracture or broken bone are all often to blame. And of course, high heels.
"Loading of the joint in that particular fashion as the toe is sort of brought up with the high heel definitely causes more force and more stress on the joints in that area and definitely may be a reason why we see when patients come in with BTA early on big bone spurs that have formed in that particular spot."
Doctor Aiyer continues, "Depending on the stage of the disease has really sort of dictated how we treat this. With lower stages or earlier grades, predominantly when there is a big bone spur on the top, you can make an incision on to the top of the big toe and remove the bone spur all the way to actually gluing the joint shut and fusing the toe when it's really bad arthritis."
"He recommended I do this joint fusion and the technology is nowhere," Carbonell says.
The Cartiva implant is made with the same material used in contact lenses. It is durable and slippery, acting much like cartilage.
"Interestingly a lot of people still use metallic joint replacements that do involve some degree of screwed mechanics or some degree of screw material," says the doctor. "The advantage with the Cartiva is the pain relief lasts for close to five years. In addition, people get between five and seven degrees more motion at the end of the surgery. You still have to make that dorsal incision, that incision on the top of the big toe to get down to the joint. The operative time is about 40% shorter. On average, a fusion can be done in about an hour whereas on average this takes anywhere from 20 to 40 minutes to complete."
In contrast to the surgery on her left foot, three months after this procedure putting Cartiva in her right foot, Carbonell was quickly out of bed and off the crutches.
"I'm very pleased. The recuperation time has been wonderful," she says happily. "Within six weeks. I was walking and doing therapy."
Her right toe is still swollen. However, Carbonell's wearing flat shoes and does so all the time now. And when she can, she tries to pass along some advice informed by her own many years in pain.
"I see these beautiful young women destroying their feet. I wouldn't want other women to suffer the way I have. The issues that come along later in life aren't worth it, it's really not worth it."
