Surgery for Big (Great) Toe Arthritis

Despite resting, inserts, and injection therapy, your big toe is still hurting. The pain is slowly getting worse and interfering with daily activities. If you’ve been diagnosed with big toe arthritis (hallux rigidus) by an orthopedic surgeon and are no longer getting relief from conservative treatments, it may be time to consider surgery.

But what are your options? Your orthopedic surgeon will have a couple different surgical treatments to discuss with you. 

Bone spur removal (Dorsal cheilectomy)

Many patients have pain on the top of their toe. This can be surgically addressed with a ‘cheilectomy’, which is removing the bone spur. This surgery preserves motion of the toe. Also, it removes that pain that occurs when patient go up on their toes or push off. Additionally, the recovery from this surgery is relatively short, as patients can get into shoes at 2-6 weeks. 

Surgeries for advanced hallux rigidus 

If you have more than just a bone spur, and you have pain with motion of the joint, you may have more advanced arthritis. A cheilectomy may not be the right surgery for you. In general, there are two options:

• Interposition arthroplasty (putting a spacer inside the joint)
• MTP fusion

What is interposition arthroplasty?

This is also known as joint resurfacing. This surgery puts a spacer, either synthetic or tissue, inside the joint. This provides a cushion for the joint. Another option is a polyvinyl alcohol spacer. 

The benefit of interposition arthroplasty is that it preserves motion. Unfortunately, not everyone gets complete relief from this surgery, or the pain returns sooner than they prefer. 

What is an MTP fusion?

A fusion is a surgery jn which all the damaged cartilage is removed, and the two bones are ‘glued’ together. This eliminates any motion at the joint, but it can be a permanent solution to the pain. Although you lose all motion in your metatarsophalangeal (MTP) joint, most patients can still be quite active. The many other joints around your MTP joint will still move. 

What is the recovery for these surgeries?

Talk to your orthopedic surgeon about the recovery time, as it varies. In general, patients are nonweightbearing or walking on their heel for the first two weeks in a boot or orthopedic shoe, and they slowly progress to full weightbearing from 2-8 weeks post-operative. 

The orthopedic surgeons at Southwest Orthopedic Group can perform in-office radiographs and discuss nonoperative and surgical treatments. 

The American Orthopaedic Foot & Ankle Society (AOFAS) has more information about hallux rigidus at FootCareMD.

For more questions or to set up an evaluation, contact Dr. Stautberg’s office at 281-977-4870. 

Author

Eugene Stautberg, MD