Big toe arthritis (hallux rigidus)
This causes pain, stiffness and swelling of the big toe metatarsophalangeal joint.
Non-surgical treatment: stiff soled shoes, injection, activity modification.
Surgical treatment: removal of excess bone (cheilectomy) or fusion (arthrodesis).
Cheilectomy: involves removing extra bone (osteophyte) from the top of the metatarsal head. This is only suitable in some cases.
Anaesthetic: general or spinal anaesthetic
Duration in hospital: 0.5 days
Fusion of 1st metatarsophalangeal joint
Anaesthetic: general or spinal anaesthetic
Duration in hospital: 1 night
During Surgery
Dr McGonagle will make an incision over the top (dorsum) of the arthritic joint. He will expose the damaged joint surfaces and remove excess bone (osteophytes), and shave (ream) the damaged joint surfaces to expose healthy bleeding bone.
The bone ends will be aligned in a straight line, compressed together and fixed with a plate and screws.
After Surgery
You will have a shoe with a large heel wedge (forefoot offloading shoe) to allow you to walk, whilst minimizing any pressure through the big toe. This should be worn for the first 6 weeks when walking.
You should elevate your foot above the level of your heart as much as possible, to minimize swelling and wound healing problems.
After 6 weeks you can progress to normal footwear.
You will have a wound check with Dr McGonagle’s practice nurse at 2 weeks and see Dr McGonagle with an x-ray at 6 and 12 weeks.
Ultimately the joint will be rigid but should have significantly decreased pain levels.
It may take 6-12 months to notice the full benefit from surgery.