Arthritis (wear of the joint) is common cause of pain and stiffness of the big toe.
Symptoms and signs include:
Pain – Particularly worse on movement of the toe
Stiffness
Difficulty with shoe wear
Difficulty with sports and recreation
Bony bump on the top of the toe
Investigations
A plain x-ray is usually all that is required to diagnose this condition. This may show narrowing of the joint space (from cartilage loss) and a bony bump (osteophyte). Occasionally a MRI scan is required to diagnose early disease.
Treatment
Early mild disease can be treated with shoe changes (wide toe, stiff sole), activity modification and occasional pain medications such as Paracetamol. There is no urgency for surgery – you should wait until your big toe is affecting your quality of life.
Surgery
Mild arthritis can be treated with removal of the bony bump. This can be effective for pain relief and improved motion of the toe.
Moderate to severe arthritis is usually treated with fusion of the big toe. This is a highly successful operation for pain relief and improved function. Despite the lack of movement in the toe patients can function at an excellent level (Several elite, professional athletes have continued their career post fusion).
An alternative to fusion is replacement of the big toe joint. This can either be a partial replacement (Cartiva) or full silicon replacement. Early to medium term results show the Cartiva to be a viable alternative to fusion. However the long-term results are unlikely to be as excellent as fusion. The main role for joint replacement of the big toe is patients who desire to keep some motion of the big toe (i.e. high heel wearers).
After your surgery
You will be in a small protective shoe and usually can commence weight bearing immediately.
You should plan to rest and elevate your foot for the first 2 weeks to aid wound healing reduce swelling.
You can leave hospital as a day case or stay overnight if you prefer.
Your dressings can remain intact until your first post – operative visit at 10 – 14 days post op.
Risks of hallux rigidus surgery
Infection
Nerve injury
Non / mal fusion
Ongoing pain, stiffness
Loosening / wear of implant (Joint replacement only)
Blood clots (DVT / PE)
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