STIFF BIG TOE JOINT SURGERY

WHAT TO EXPECT WITH GREAT TOE SURGERY

 

THE BASICS

This is very similar to a bunion in that you have pain in the great toe joint as well as a prominent bump; however, the underlying structural of the joint varies from that of a classic bunion. In addition, patients typically experience stiffness along with pain in the big toe joint. Some individuals develop a painful bone spur or prominence on top of the joint as well. This differs from a bunion in that the painful bump occurring with a bunion is on the side. Regardless of the location of the prominence, this can lead to irritation while wearing various shoes. The other major difference from a typical bunion is the loss of joint space secondary to the structure and overall mechanics of your foot. When the joint becomes tight, the cartilage is physically worn down to the point where there is bone on bone contact, which causes significant “grinding” between the bones. Small pieces of bone can also break off within the joint, exacerbating the pain and swelling.  

Surgical intervention for a stiff or arthritic great toe joint is the last resort when conservative treatment options have failed. Anti-inflammatories (both oral and topical), shoe modifications, orthotics, cortisone injections, and physical therapy are all options that can alleviate the pain associated with the arthritic changes of the joint. When this fails, surgery is available to give you pain relief. 

THE SURGERY

There are multiple surgical options in regards to treating a painful and stiff great toe joint. The simplest procedure that enables patients the quickest recovery is simply removing the prominent spurs and “cleaning up the joint” This procedure, known as a chilectomy basically remodels the joint by removing all scar tissue and extra bone growth. No bone cuts are performed and therefore eliminated the need for bone to heal. The main drawback to this option is it’s inability to alter the amount of joint space and typically relief is short lived. Patients will experience pain relief for multiple years, however, at some point may require an additional procedure as the joint continues to breakdown over time.

Taking the chilectomy a step further would include making a bone cut and shifting a portion of the bone, in essence trying to create additional joint space. This is very similar to the procedure done for a typical bunion in that the metatarsal would be stabilized with some form of implant like a bone screw. This additional procedure will in some cases give patients better long-term relief as it helps to decompress the joint. This will also extend the post-operative recovery period to roughly six weeks of downtime or decreased activities. As with bunion surgery, patients are able to walk on their foot immediately after surgery.

If there is extensive cartilage destruction within your great toe joint, a joint fusion may be the most optimal procedure. Fusing the great toe joint will give immediate relief and is the most definitive procedure available. As this will essentially limit the motion available to the joint, one can think of it as trading what little remaining motion that you have for long-term pain relief. The procedure involves removing all remaining cartilage between the two joint ends and stabilizing the two bone ends into one. Implants including screws, pins, and or a small plate may be used to achieve a successful fusion. Patients are able to walk immediately afterwards on the foot in a protective boot.

Other surgical options available that you can discuss with you physician include a total joint replacement and removing a section of the joint altogether. The procedures described above can all yield excellent pain relief and functional ability. The right procedure for you will be determined based on many factors including but not limited to: age, activity level, and nature of the joint structure. 
 

AFTER SURGERY

The post-operative course for this surgery includes a sterile dressing and protective shoe or walking boot. The dressing is not to be changed or tampered with until seen by your doctor one week after surgery and is not to get wet. Patients are permitted to walk on the operative foot as tolerated immediately after surgery, however, it is important to keep the foot dry for the first two weeks. At two weeks after surgery, all bandages are removed and patients are permitted to wet the foot while bathing. It is at this point that patients can transition back to a supportive athletic shoe as tolerated. In general, I advise individuals to decrease their normal activities for six weeks as post-operative pain and swelling is correlated to patient activities. Although everyone heals at a different rate, in some cases swelling can occur for up to a year after surgery. Patients are advised to take a minimum of one week off from work to recover from the anesthesia and the procedure.  

IF YOU ARE CONSIDERING SURGERY FOR YOUR GREAT TOE CALL TODAY TO FIND OUT MORE ABOUT YOUR OPTIONS: 770.979.0900



GREAT TOE SURGERY: BEFORE & AFTER