Orthopaedic Surgery - Arthritis of the big toe (Hallux Rigidus)

What is Hallux Rigidus?

Hallux Rigidus is the term used to describe arthritis in the first metatarso - phalangeal (MTP) joint, which is the base of the big toe.

It is known as Hallux Rigidus, as hallux means big toe and rigidus means stiff.

Arthritis results in the soft protective cartilage layer around the end of the bones become worn away causing pain and stiffness. There may also be boney lumps close to the joint which prevents the toe from bending as much as it was able to.

What are the causes?

Hallux Rigidus can occur through wear and tear, or injury to the joint damaging the protective cartilage layer, long term bunions left untreated along with conditions such as rheumatoid arthritis will also cause the joint to become worn, stiff and painful.

What are the treatment options?

Non-operative treatment may be offered initially if appropriate.

This depends on the severity of the pain and stiffness in your big toe along with any other medical conditions you may have, such as diabetes or circulatory problems.

These include:

• Painkillers
• Steroid injections
• Insoles provided by an orthotist
• Wearing stiff soled shoes or rocker soles

Operative treatment may be offered once the above options have been explored.

The operation usually involves a general anaesthetic (asleep) with a local anaesthetic ankle block to provide good pain relief following surgery.

What is a Cheilectomy?

A cheilectomy is performed to remove the bony lumps that form on top of the big toe.

This will reduce the pain and allow increased movement but not cure the arthritis. It is the treatment of choice for mild arthritis.

The operation involves an incision (cut) being made along the top of the big toe. The bony lumps are removed and the toe is moved up and down to ensure it has a good range of movement.

You will be given a post-op shoe to wear for a couple of weeks. It is important to begin moving your toe up and down to maintain the range of movement immediately after surgery.

An outpatient physiotherapy appointment will be organised for you.

What is an MTPT Fusion?

A fusion is when the joint is permanently stiffened, creating a union between the 2 bones on either side of the joint. Also the bony lumps are taken away and any deformities are corrected.

An incision is made along the top of the big toe. The surfaces of the joint are removed on either side of the joint.

The bones are held together and positioned carefully to correct any deformity. Metal plates and screws will then permanently hold the bones in the correct position and allow them to heal and fuse together.

As the bones heal, they will appear as one bone with no joint. This means the toe will not bend at that point, however, the tip of the big toe will bend.

You will be given crutches and a special shoe that has a large heel to wear for at least 6 weeks. This is to allow the wound and bone to heal.

Can I walk after the operation?

Following either operation you will be able to walk with the special shoe and crutches, however, you should not walk for more than 10-15 mins in the hour.

At all other times it is imperative that your foot is elevated above the level of you heart to control the swelling in your foot for 6 weeks.

What are the risks?

There are general risk relating to all surgery of the foot which includes swelling, infection, scarring, numbness and blood clots.

The main specific risks are failure of the bones to fuse. This risk is increased in patients who are diabetic, have rheumatoid arthritis and in those who smoke. We advise you to stop smoking prior to the procedure.

Will I be able to wear normal shoes?

Once your foot has fully healed, you will be able to wear normal shoes. It is recommended that you wear stiff soled shoes or trainers for support.

Following the MTPJ Fusion you will not be able to wear heels greater than about 2.5cm (1 inch) due to the fixed position of your toe.

For Further information

Please inform staff of any concerns or questions you may have. We will do our best to answer your queries quickly.