Arthritis of the Big Toe Joint – Hallux Rigidus

What is Hallux Rigidus?

Osteoarthritis of the big toe joint is known as hallux rigidus. Hallux Rigidus is a technical term for a stiff big toe. Osteoarthritis occurs when there is damage to the cartilage of the joint which the body cannot repair. This results in a painful stiff joint.

What are my treatment options?

Non-surgical treatment will not ‘cure’ your arthritis. These treatments are with a view to managing the pain associated with arthritis.

• Activity modification
• Footwear modification – footwear with a rigid sole or rocker bottom may help
• Joint injections are for pain relief but is a temporary solution.
• Use of protective and cushioning shields, splints and/or insoles/orthoses

Surgery

Surgery is usually a reasonable option if you are experiencing pain and limitation in your daily activities. There are several procedures which may be considered for these conditions.

1. Cheilectomy: This involves shaving of the excess bone and improving motion.
2. Fusion: This involves preparation of the joint and fusing it with plates or screws. You will not have any future movement in the joint.
3. Resurfacing procedures: This involves replacing the cartilage with an artificial joint.

Mr Ray offers a new and unique non-metallic big toe joint replacement called the CARTIVA.

This is the insertion of a prosthetic joint spacer. The aim of the surgery is to reduce pain and restore movement of the arthritic joint affected by hallux rigidus.

This procedure helps to maintain movement in the big toe joint. This allows patients to wear heels and allows normal physiological walking.  The results have been excellent and may replace fusion as a treatment of choice for arthritic big toe joints.

What are the benefits of surgery?

• To reduce pain
• To improve comfort
• Localised procedure which does not involve other joints

Are there any risks?

The general risks of foot surgery like infection, nerve injury, swelling and stiffness.

In addition to this, there are the following specific risks for this procedure:

• Joint stiffness
• Floating toe (the toe sticks up in the air rather than being in line with the other toes)
• Failure, dislocation or fracture of implant requiring its removal
• Implant reaction requiring its removal (0.05%)

As with all prosthetic joint implants, there is a lifespan. Current literature suggests an average of between 8 and 10 years before the implant may need replacing. This obviously varies dependent on your level of activity.

What does the operation involve?

This operation is performed under a general anaesthetic. The excess bone is removed from around the joint. The metatarsal head is prepared. The implant is inserted into the metatarsal head.

How long does the operation take?

The operation for hallux rigidus usually takes between 30-40 minutes.

Is this a day procedure?

Yes, you can go home on the same day.

Will I have a plaster cast?

This is not necessary for this procedure. You will be provided with a hard-soled post-operative shoe for full mobilisation.

Will I have any screws or pins in my foot?

Apart from the implant, there are no other screws or pins used for this procedure.

How long will I need off work?

This will depend on the job you do and the speed of your recovery. For non-manual work, we usually recommend approximately 4-6 weeks. For manual work approximately 6-8 weeks.

When can I drive?

You may return to driving if you can perform an emergency stop. You must check with your insurance company before driving again. This is usually between 4 to 6 weeks.

Who can I speak to if I would like more information about the procedure?

It is important that you understand what the procedure involves before giving consent. This includes any potential risks, benefits and alternatives. Although these will be explained to you

beforehand please don’t hesitate to ask either your consultant or one of the team if you have any further questions.

Post Op recovery

The operation is performed under general anaesthesia. The operation takes about 30-40 minutes, although you can expect to be in the day surgery unit for about 3 hours.

For your safety you must have a competent adult at home for the first 48 hours following surgery.

First 2 – 14 days

The pain is usually at its worst in the first 2 – 3 days but you will be given painkillers to help. You must rest completely for 2 – 4 days with your foot elevated just above hip level.

You may be advised to keep the circulation going by gently drawing circles in the air or wiggling your toes.

You should restrict your walking to going to the bathroom only.

You will be given a special shoe and crutches you must use them in the way shown.

You may be able to bear a little weight on the foot depending on your pain tolerance.

As the pain decreases you can improve your walking and dependence on the crutch.

We advise active toe movement to maintain maximum range of motion.

Two weeks after surgery

You must attend clinic again for your stitches to be removed.

Your foot will still be quite swollen, but you should be able to get a roomy shoe on.

You should bring a lace up broad fitting and supportive shoe (ideally a trainer) with you. Provided that the wound is well enough healed, you should be able to get the foot wet.

Between 2 – 6 weeks after surgery

The foot starts to return to normal and you can return to shoes.

The foot will still be quite swollen, especially at the end of the day.

You may require a review appointment at 4-6 weeks.

Whilst normal activity will be resumed, sport should be avoided.

Between 8 – 12 weeks after surgery

The foot should continue to improve and begin to feel more normal again. There will be less swelling. Sport can be considered after 3 months, depending on your recovery.

Six months after surgery

You will have a final review between 3 and 6 months following surgery. The swelling should now be slight, and you should be getting the full benefit of surgery.