Big toe arthritis surgery
Big toe arthritis surgery
Big toe arthritis surgery
Big toe arthritis surgery
What is Big toe arthritis surgery
Big toe arthritis (Hallux Rigidus) affects the joint between the big toe and the foot (aka 1st metatarsal phalangeal – MTP joint). It causes pain, swelling and stiffness, and patients find the ability to bend the toe upwards (dorsiflexion) is very restricted or completely lost. Sometimes a bump (osteophyte) may develop on the top of the joint, which may cause rubbing in footwear.
In early big toe arthritis, you may find it beneficial to wear a stiff-soled shoe with a wide toe box, and a steroid injection of the joint may give some relief. We may also be able to improve your symptoms with a ‘cheilectomy’ surgery (which removes the bump on the top of the joint, and restores some movement), or osteotomy surgery to slightly shorten the toe and offload the joint.
In advanced big toe arthritis, fusion surgery is likely to be your best option. The goal of big toe fusion surgery is to make your toe pain free, but it will still be stiff. If you have big toe arthritis, you will probably already experience stiffness, but it will be painful. The goal of this surgery is to go from stiff and painful to stiff and pain-free toe.
In terms of footwear, it will be possible to wear a small heel (about an inch in height or so). After your surgery, you should be able to enjoy most types of sports and most people may be able to manage some light jogging if they wear a stiff-soled trainer with a rocker bottom.
What about joint replacement surgery?
There have been many big toe joint replacements produced, but unfortunately, most of them have not been able to provide the desired outcomes for patients, as evidenced by their high failure rates. In situations where the arthritis has affected the joint between the big toe bones (the 1st interphalangeal – IP joint is also arthritic), I may suggest big toe joint replacement because it’s very difficult to get a successful outcome from fusing both joints. If this is the case, I would use a silastic (silicone) implant.
What does the foot fusion surgery involve?
Big toe fusion surgery is a day case procedure usually carried out under a general anaesthetic (or a spinal anaesthesia). Regional anaesthesia is also available with the patient being awake.
A short incision is made over the medial aspect (inside) of the arthritic big toe joint, and then the damaged joint ends are removed, and the ends of the bones are fixed together with screws or plates. These are permanent fixtures, however, in rare cases, they might cause skin irritation and may need to be removed.
What’s the recovery like after big toe fusion surgery?
After the surgery you’ll spend a short time in the recovery area, and then you’ll return to the ward. To ensure your comfort once you wake up, your foot will be temporarily numbed with a local anaesthetic injection. You’ll have a bulky dressing on your foot, and upon leaving the hospital, you’ll receive a surgical shoe to protect your foot. While you can bear weight in the shoe, it’s essential to keep your foot elevated above your heart until your wound has healed.
After three weeks, we’ll meet again in clinic to remove the bulky dressing and trim stitches. You should continue wearing the surgical shoe for 3 more weeks.
At our six-week follow up appointment, we’ll take an X-ray to ensure everything looks good. If it does, you can switch to wearing trainers for the next four weeks, and then your regular footwear after that. I advise avoiding high-impact activities, such as running, for six to twelve weeks. After twelve weeks from the time of surgery, you should be back to doing all the things you enjoy.
When can I drive after foot fusion surgery?
You can drive when you’re able to walk normally on your foot and can execute an emergency stop. This is usually achievable 8 to 12 weeks after surgery. If you drive an automatic car and are having an operation on your left foot, you can drive once you’re able to get in and out of the car comfortably.
When can I return to work after foot fusion surgery?
Returning to work after foot surgery depends on the nature of your job. If you have a desk job, it is usually safe to return after three weeks, as long as you can keep your foot elevated. However, if you have a manual job, it may take up to three months for you to be able to return to work safely.
How successful is foot fusion surgery?
More than 95% of patients report that they have had an excellent pain relief after big toe fusion surgery. It’s important to keep in mind that while the bones may take up to three months to fully fuse, most patients will start experiencing pain reduction within four to six weeks of the surgery if not earlier. If you’re looking to get back to sports, it’s typically safe to start after three months post-surgery.
