Big Toe Arthritis Treatment London | Private Ultrasound Diagnosis & Injections

Big Toe Arthritis Explained

Big Toe Anatomy

The 1st metatarsophalangeal joint (MTP joint) is the anatomical name for the main joint of the big toe.

This joint performs a complex function during walking and running, requiring:

• Flexibility into extension during toe-off

• Tilt and rotational motion to adapt to uneven surfaces

It also serves as the attachment site for powerful muscles and tendons that manipulate foot movements and assist with forward propulsion during toe-off.

1st MTP Joint Osteoarthritis Symptoms

The most common complaint with 1st MTP joint arthritis is pain around the upper and inner aspect of the joint during walking.

Other symptoms may include:

• Creaking or clicking in the joint

• Stiffness in the joint as the arthritis progresses

• This stiffness can interfere with maintaining a normal walking pattern

1st MTP Joint Osteoarthritis Causes

Due to the high functional demands on the 1st MTP joint, as well as certain individuals' genetic predisposition or a history of previous injuries to the joint, degenerative changes may develop in the joint surfaces and surrounding soft tissues, particularly in middle-aged and older adults.

Diagnosing 1st MTP Joint Osteoarthritis

The location of the 1st MTP joint (at the inner side of the forefoot) makes it ideally suited for ultrasound imaging.

Ultrasound can:

• Clearly visualise the joint margins

• Detect bony irregularities

• Identify thickening and inflammation within the joint cavity and joint capsule (a common finding in osteoarthritis)

Ultrasound can also exclude other causes of big toe pain, including:

• Tears or degenerative changes of the plantar plate

• Tenosynovitis (swelling of the extensor or flexor tendons) of the big toe

• Injury to the sesamoid bones

Ultrasound Guided Injections for 1st MTP Joint Osteoarthritis

How is an Injection Administered to the 1st MTP Joint?

When 1st MTP joint arthritis causes unmanageable pain or begins to interfere with walking or running, an ultrasound-guided injection can be considered.

There are two commonly used techniques for performing an ultrasound-guided injection of the 1st MTP joint:

1️⃣ Longitudinal (in-plane) technique:

The ultrasound probe is placed in a longitudinal orientation over the dorsal (upper) aspect of the 1st MTP joint.

One end of the probe points towards the tip of the big toe and the other towards the ankle.

Some stand-off gel is applied beneath the distal end of the probe to aid visualisation of the needle entry point.

The needle is visualised as it is advanced from distal to proximal under the probe, entering the 1st MTP joint, with injectate seen flowing into the joint.

2️⃣ Out-of-plane technique:

This approach may be preferred when there are significant osteophytes (bony enlargements) on the dorsal aspect of the joint, which can impede needle access during an in-plane approach.

The probe is placed over the upper dorsal aspect of the joint.

A centreline tool is used to accurately line up the joint cavity.

The needle is then carefully introduced out of plane, entering at an angle determined to allow the needle tip to be visualised within the centre of the joint cavity, where the injectate is then delivered.

What to Do After Your 1st MTP Joint Ultrasound Guided Injection

Needle Path & Post-Injection Pain
1st MTP joint injections  are administered through the dorsal top part of the joint. Thus, the superficial nature of the structure means there is no significant needled trauma. In some cases it may be advantages to inject larger volumes of local anaesthetic into the joint. In some cases this distention of the joint capsule or the steroid's interaction with the joint fluid or subcutaneous tissue may cause a post injection flare typically lasting 2–3 days. If this occurs, over-the-counter painkillers (as directed on the patient information leaflet) can be taken.

Wound Care & Infection Risk
Avoid exposing the injection site to dirty or public water (e.g., swimming pools, hot tubs) for 2–3 days to reduce infection risk. Monitor for redness, swelling, or discharge at the injection site and contact me immediately if these occur.

Activity Guidance
Sensible graded activity can usually resume after 2–3 days, provided symptoms allow.

Follow-Up
If you experience unusual pain, swelling, redness, or any other concerns following your injection, please contact me immediately.

Other Treatments for Big Toe Arthritis

Mobility Exercises for Big Toe Arthritis

Strengthening Exercises for Big Toe Arthritis

1st MTP Joint Osteoarthritis | Evidence base

Big toe arthritis, most commonly affecting the first metatarsophalangeal (MTP) joint, is a degenerative condition characterised by pain, stiffness, reduced dorsiflexion, and impaired gait and push-off. Symptoms often progress gradually, with intermittent inflammatory flares. Evidence supports a stepwise conservative approach, including footwear modification, orthoses, activity modification, and targeted strengthening. Intra-articular corticosteroid injection has moderate evidence for short-term pain relief, particularly during symptomatic flares or when pain limits walking and function. Due to the small joint size and frequent osteophyte formation, ultrasound guidance significantly improves injection accuracy compared with landmark techniques and reduces the risk of extra-articular injection. While long-term outcomes are similar regardless of technique, studies suggest US-guided injections provide more reliable early symptom relief, especially in patients with advanced disease or prior failed blind injections. Repeat injections should be used cautiously due to diminishing benefit and potential local tissue effects. Surgical options are reserved for patients with persistent pain and functional limitation despite comprehensive conservative management. Overall, ultrasound-guided intra-articular injection is a useful adjunct for short-term symptom control in big toe arthritis and can help maintain mobility and participation in rehabilitation.

Questions about your toe pain?