When the main joint of the big toe in the ball of the foot gets worn out, it can become arthritic. This can affect either the upper part or the whole of the joint. The condition is known as ‘hallux rigidus’ because it makes the big toe (‘hallux’) stiff and sore (‘rigidus’).

Symptoms

Pain and stiffness are felt in the big toe. It may not be possible to turn the big toe up. To compensate, some people will walk on the side of their foot, which can spread pain to the ball and outside edge. A bony bump (‘osteophyte’) might develop which can rub on shoes.

Treatment

Painkillers or anti-inflammatory medicines can help relieve the pain if it is affecting your daily life. Stiffening the sole of your shoe helps prevent the foot from bending during walking. Make sure to wear comfortable, well-fitting shoes. If pain persists, steroid injections into the joint can bring improvement.

Surgical options depend on whether the upper or the whole of the joint is affected. Mr. Samarji who specialises in treating Big Toe Arthritis uses cheilectomy on the upper joint to trim the bone and has a high success rate. When the whole joint is involved, a fusion or a replacement can be considered. These procedures depend on the age and activity of the patient.

Do I need an operation?

Usually, the choice comes down to deciding whether or not shoewear (a stiff soled shoe / rocker bottom shoe) or one of the operations available for treatment of arthritis of the big toe is something that you would wish to undergo. Essentially the treatment is for pain relief and if shoes are not helping then surgery is something that can be considered and is often successful.

If I need an operation what is involved?

There are mainly four different types of operation for treatment of hallux rigidus (arthritis of the big toe). The gold standard procedure is a fusion. This involves fusing the joint to prevent movement. The abolition of movement also abolishes the pain. Most patients are very happy with the results, and indeed are pleasantly surprised that their gait has not been significantly altered and patients are able to walk very normally following a fusion. The other procedures allow for movement at the joint. A cheilectomy involves taking away some of the extra bone at the top of an arthritic joint that can result in pain relief. It usually lasts for approximately four years before remaining arthritis deteriorates to the point where a more formal procedure such as a joint replacement or a fusion needs to be done. A joint replacement is a useful procedure for dealing with arthritis at the toe joint. A Keller’s procedure (excising a part of the joint) is usually reserved for patients that wish to wear high heels.

At the consultation, the merits of each procedure will be explained in order that you can make the right choice about how you wish to proceed.

Following an operation how long will I be in hospital?

Surgery for a hallux rigidus (arthritis in the big toe) is normally carried out as a day case.

How long will it be before I can get back to being active?

Following a fusion, you will need to walk on the outside of your foot for approximately six weeks. It may be possible to go back to an office type job, but particularly with regard to the right foot, it will not be possible to drive a car until the bone has healed, which takes about six weeks. It is possible to get back to playing sports at about three months following the procedure.

With regard to the cheilectomy, there are no restrictions on weight bearing. Once the skin wounds have healed at approximately two weeks you will be able to go back to work. It will be easier to return to an office type job at approximately 10 to fourteen days. For a more manual job, it may be four weeks before you return to your full duties. You should be able to return to sports at approximately six weeks following a cheilectomy.

Following a joint replacement, you will need to walk on the outside of your foot for approximately six weeks. It may be possible to go back to an office type job, but particularly with regard to the right foot, it will not be possible to drive a car until the bone has healed, which takes about six weeks. It is possible to get back to playing sports at about three months following the procedure.

Following a Keller’s procedure, there are no restrictions on weight bearing. Once the skin wounds have healed at approximately two weeks you will be able to go back to work. It will be easier to return to an office type job at approximately 10 to fourteen days. For a more manual job, it may be four weeks before you return to your full duties. You should be able to return to sports at approximately six weeks following a Keller’s procedure.

Will I need any physiotherapy?

Usually, physiotherapy is not needed following a fusion, a cheilectomy or a Keller’s procedure for hallux rigidus (arthritis of the big toe). Physiotherapy is usually needed following a joint replacement in order to maintain movements and minimise the risk of stiffness in the joint.

Patients who have pain at the great toe as a result of arthritis often get into the habit of walking on the side of the foot and after a successful operation, a short course of physiotherapy to re-learn how to walk through the inside of the foot may be needed by some patients.

What are the risks of the operation?

All surgery carries risks and complications. These will be clearly explained in the consultation and a consent form at the consultation is signed with all the risks set out. The risks include infection, clots, bones not knitting together, bleeding and complex pain. It is important that the risks are understood in order to weigh up the decision about whether or not you wish to go ahead with surgery as it is also important to be aware of the other options open (non-surgical options).