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Stiff Big Toe Surgery

What operations can be done?

An operation may be considered if simple treatments do not improve the pain in your foot. An operation is always optional. How much pain you have in your foot will help you decide whether you need an operation. 

What about the anaesthetic?

You will meet the anaesthetist before the operation so that they discuss which anaesthetic will be best for you. The operation is usually done under general anaesthetic. A nerve block to numb the toes helps with pain relief immediately after the operation. 

What operations are available?

Cheilectomy (shaving the bone spurs)

In early arthritis a simple operation can be done to remove the bone lumps and smooth off the joint. As well as removing the bone spurs this will relieve pain and increase the range of movement of the joint. This can be done as an open or a minimally invasive keyhole operation. 

Sometimes this is combined with a minor resetting of the bone at the base of the big toe (Moberg osteotomy) to further increase the upward bending movement of the toe. 

Fusion of the 1st toe joint

There is a cut of about 6cm on the top of the foot, along the line of the great toe. Any bone bump is removed. The remaining cartilage in the joint is removed and the bones are fixed in position with either screws, staples or metal plates.

The two bones then have to heal and the joint must be protected during this time. The screws, plates or staples are strong enough to hold the bone but not strong enough to take your weight so you would be given a protective shoe which allows you to walk without loading the toe. 

Fusion is a very effective way of controlling pain for most people. The disadvantage is loss of movement which can restrict choices of footwear and have an effect on some activities which involve upward bending of the toe.

For people with the problem in both feet there is the option of having surgery on both feet at the same time. Most people having an operation on one foot can be treated as a day case. People having an operation on both feet may need to stay in hospital overnight.

Cartiva joint replacement

We introduced the Cartiva joint replacement to Scotland in 2016 and our surgeons have the longest experience of using it. Replacement of joints of the big toe has proven challenging over the years and is not suitable for all people. Your surgeon would be able to assess your foot and discuss with you which is the best option for you. 

The Cartiva is a synthetic cartilage implant designed to preserve movement in the great toe joint. The implant is inserted into the first metatarsal bone and all bone spurs are removed. The Cartiva creates a smooth joint surface and separates the exposed worn bones allowing increased movement and alleviating pain. You can walk on the great toe straight away. After two weeks of bandaging you can get back into shoes. 

Is the surgery painful?

You may have a local anaesthetic nerve block to relieve pain immediately after the operation – this means you wake with the foot feeling numb but with no pain.  

What happens after the operation?

You will have a bandage on your foot for about two weeks. After cheilectomy or Cartiva you have a simple protective shoe for two weeks. After fusion you wear a forefoot off-loading shoe (figure 3) to walk for six weeks.  You are more comfortable if you elevate your foot as much as possible on a footstool, recliner chair or sofa. 

A physiotherapist will see you on the ward by either before or after the surgery. They will show you how to mobilise and to do stairs while recovering.

You will have a clinic appointment about 2 weeks after your operation. Dressings will be changed and the wound checked. Stitches are usually dissolvable and so only need trimming back in clinic. X-rays are taken at two weeks after the Cartiva operation or six weeks after fusion.

When can I return to work?

You can return to desk work at around 1- 4 weeks after your operation. Remember to sit with your foot propped up. If you are on your feet for longer periods it may be 2-3 months before you are comfortable enough to get back to work.

It will take 2-4 weeks (or six weeks after fusion) before you can safely use the foot pedals in your car.

What are the possible problems after the operation?

Any operation has risks. After 1st toe surgery these problems can be:

  • The bones not healing after fusion (non-union). This can sometimes require the operation to be done again
  • Ongoing pain. This is a risk of any operation. About 10% of patients having the Cartiva can have persistent pain and this can require conversion to fusion.
  • Progression of arthritis – this can happen after cheilectomy or Cartiva. It cannot happen after successful fusion as there is no longer a joint.
  • Healing in a painful position (mal-union) – after fusion there is a risk of the toe healing out of line
  • Numbness – loss of feeling in the big toe
  • Infection
  • Swelling that does not settle
  • Metal staples or screws requiring minor surgery to remove them after fusion
  • Blood clots in the leg or lungs
  • Nerve related pain

Interested in treatment options?

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