Arthritis of the Big Toe Treatment – Melbourne
Hallux Rigidus or Arthritis of the Big Toe
– A Patient’s Guide:
Mr Troy Keith MBBS (Hons), FRACS (Orth), FAOrthA
Orthopaedic Foot and Ankle Surgeon
What is Hallux Rigidus
Hallux rigidus is the Latin term for a “stiff great toe”. It’s commonly caused by arthritis of the big toe as the result of repeated trauma.
If you suffer from Hallux rigidus your big toe will be stiff and sore and often have a bump over the top of the joint – See to Figure 1, shaded area.
You will most likely be experiencing pain in your toe on upward bending during walking or running.
(See shaded area at the top of the big toe joint).
Is a bunion the same thing?
No – A bunion is caused by sideways drifting and angulation of the great toe (known as hallux valgus).
The lump in a bunion is found on the inside of the big toe as opposed to the top in hallux rigidus.
See Figure 2.
Although Hallux rigidus and bunions are different, some people can have both.
The Treatment of Hallux Rigidus
Without an operation
Your doctor may recommend anti-inflammatory medications or a cortisone injection to relieve the pain in your toe. Wearing a stiff soled shoe may also limit the movement of your toe, reducing toe movement and pain.
With an operation
Surgery should only be undertaken if your symptoms are significantly affecting your function and everyday life. There are two types of surgery:
- Cheilectomy
- Fusion
What is a Cheilectomy operation?
A Cheilectomy is an operation to remove the bump of bone on the top of the big toe. It is successful in reducing symptoms in approximately 90% of patients with less severe arthritis. If cheilectomy fails, it is still possible to perform fusion at a later date.
After cheilectomy patients may have persisting stiffness, and the arthritis may also progressively worsen over time.
The recovery from cheilectomy is quicker than the recovery from fusion. Over the first two weeks you will be in a stiff soled shoe, to allow the skin to heal. After this you will be advised on exercises to start the joint moving. Performing these exercises early, and regularly will help you to achieve the best possible result from your surgery.
What is a Big Toe Fusion?
A Big Toe Fusion is an operation to permanently stiffen the big toe.
In this surgery, the bony bump is removed and the two bones of the big toe are fused together – Refer to Figure 3.
The goal of the operation is to have patients weight bearing through their big toe again.
Fusion normally involves using two internal screws.
Your foot is protected in a post-operative shoe for six weeks, worn full time.
Arthritis of the Big Toe Treatment – Melbourne
What can I expect after the operation?
Both types of surgery are usually performed either as a day-case (where you go home the same day), or with an overnight hospital stay.
After the operation, the foot is always a little sore, but this is generally well controlled with regular pain medication.
You will need to keep your foot elevated as much as possible following your operation to reduce swelling. Please discuss with Mr Keith other options to help improve your swelling.
What can I do once I leave hospital?
You will need to rest with your foot up most of the time, when sitting elevated on a chair, or on a pillow when lying down. When the foot is lowered it will throb and swell. This should be avoided. With time, the period you can keep the foot down will increase. After two to three weeks you should be able to keep it down most of the time.
At around two weeks after surgery, you will return to the clinic for follow up. Following this your recovery will depend on the type of operation you have had.
Cheilectomy:
After cheilectomy you will start your exercises to mobilise the foot. A runner or other supportive shoe should be worn.
Fusion:
You should expect to spend six weeks in the post-operative shoe. After this an open-toed sandal with adjustable straps or runners or other supportive soled shoe should be worn. It usually takes a further four to six weeks before you can wear a standard shoe for a full working day.
Overall it is usually three to six months from the operation before you can hope to resume recreational walking or light sporting activities.
In the longer term, many patients will be able to run and participate in sports after a fusion. This cannot be guaranteed.
If you are slower than these times do not panic, they are only averages, but let Mr Keith know when you attend your follow up.
Arthritis of the Big Toe Treatment – Melbourne
Potential complications
Although the operation produces good results in most cases, complications may occur. Despite the great care that is taken with the operation and aftercare, a small number of people may have less than perfect results due to problems such as:
1. * Non-union – Non-healing of the bone that may require further surgery. Smoking increases the risk of this complication considerably.
2. * Mal-union – The position in which the toe is set can also cause problems. Women may find that they cannot wear high heeled shoes after a fusion. A few people will find that the position in which the toe is set does not suit them individually, and may consider further surgery to adjust this.
3. Sensitisation of the foot due to damage to the small nerves and blood vessels.
4. Weight transfer to the second toe (a callus under the second toe).
5. Infection.
6. General complications of lower limb surgery such as thrombosis (a blood clot) and anaesthetic problems.
(Note – *These complications may occur only after fusion surgery).
You may reduce the risk of complications by preparing yourself and your foot, as described in our handout, “Preparing for Foot Surgery”.
If you are at particular risk of complication, Mr Keith will discuss this during your consultation.
How do I know if I have an infection?
After your surgery when your foot is lowered down it will throb and swell. This is normal and can continue up to two weeks following your operation.
Please note – If you have been consistently elevating your foot and taking regular pain medication but are still experiencing considerable pain and swelling contact Mr Keith’s rooms.
These symptoms may indicate an early infection.
Arthritis of the Big Toe Treatment – Melbourne
A Message from Mr Keith
These guidelines are intended to help you understand your treatment and prepare for your operation.
I understand the level of detail may cause concern or worry for some patients.
If you do have further questions, please don’t hesitate to ask me at your consultation or contact a member of my team.
We will happily address your concerns.
It is important for me that you feel comfortable and satisfied you have all the information you need before your surgery day.
Mr Troy Keith – Orthopaedic Foot & Ankle Surgeon.
Any questions please email
Arthritis of the Big Toe Treatment – Melbourne
Mr Keith sees patients from all over Melbourne to diagnose and treat big toe arthritis. Mr Keith consults from the following practice locations in Melbourne including Malvern, Armadale, Richmond, Heildelberg and Shepparton in country Victoria.