Arthritis of the Big Toe
The base of the big toe is the most common site of degenerative changes in the foot. Wear and loss of elasticity in the cartilage cushioning the joint near the big toe causes pain, swelling and stiffness. Since the big toe moves upward every time one takes a step while walking, arthritis can develop because of repetitive trauma to the joint.
Arthritis of the big toe or hallux rigidus usually develops between the ages of 30 to 60. However, it may also be experienced by younger adults who are athletic or have encountered some trauma to the joint while walking. When the cartilage is damaged through wear-and-tear, bone spurs may develop in the joint and prevent the toe from moving upwards while walking.
Symptoms also include the appearance of a bump like a bunion or callus on the top of the foot and inability to move the toe up or down due to stiffness and pain. In some cases there may be significant deformity of the joint and foot.
Diagnosis is confirmed by x-ray imaging which will show bone spurs and degeneration of the cartilage in the joint.
Initial treatment consists of rest, medications and physiotherapy. When non-surgical treatment is not effective in treating the condition, surgical options must be considered.
Toe Joint Replacement
This type of surgical procedure for the big toe is indicated in older patients who have severely damaged joint cartilage. Removal of bone spurs alone by a procedure called cheilectomy cannot provide adequate treatment in these cases. Furthermore, the other option for advanced arthritis which is fusion of bones (arthrodesis) results in limitation of motion since the bones will be fused permanently.
With toe joint replacement a prosthesis or artificial joint made of ceramic, plastic or metal is surgically implanted after removing the damaged parts of the bones and cartilage. This may be done under general or regional anesthesia and may last for less than an hour. The patient may be discharged from the hospital on the same day of surgery unless there are complications or indications for a longer stay.
Initially he will be given pain medications and will be asked to rest and elevate the foot. After recovery the patient will be advised to undergo physiotherapy. He will be required to wear a special shoe or boot and encouraged to walk gradually with or without support. He will be able to do more activities in six weeks although high impact sports are to be avoided. Other sports such as swimming and golf may be done under medical advice.
The complications of the procedure are similar to other surgeries such as pain, bleeding, numbness and infection. However, revision of the surgery may be done if later complications occur like:
- Loosening of the prosthetic joint
- Infection of the implant
- Stiffness and persistent swelling of the joint
- Biomechanical problems
Improvements in techniques and designs for big toe replacement are still needed since historical results have been poor. The procedure may relieve pain and preserve motion of the joint but there are still some drawbacks in the procedure.
American Academy of Orthopaedic Surgeons, “Stiff Big Toe (Hallux Rigidus)", accessed 1/19/11
The Foot and Ankle Practice, “Total Big Toe Replacement", accessed 1/19/11