The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. Arthritis in the big toe can cause a number of problems. The need for surgery depends on how bad the arthritis is and how much pain you are experiencing. Surgery is recommended for those with pain and stiffness in the big toe joint. Some patients are unable to wear certain shoes (dress shoes, high heels and boots) and can’t participate in activities due to pain. If the condition exists in both feet, the more painful foot is operated on first.
Hallux Rigidus is arthritis in the big toe. Arthritis develops when the cartilage on each bone wears away and the two bones that make up the big toe joint rub against one another. Bones spurs, which block the toe’s motion, may develop due to arthritis. This progressive disorder renders the toe stiff and unable to move. This condition can cause pain and swelling and lead to difficulty walking, running, and wearing shoes.
Big Toe Arthritis (Hallux Rigidus)
Hallux rigidus is arthritis of the joint at the base of the big toe.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. Before deciding on surgery, patients should try non-surgical treatment such as changes in activity and footwear or steroid injections. Patients also can try wearing a shoe with a rounded bottom or using carbon shoe inserts that limit joint motion.
You should avoid surgery if you have an active infection or severe narrowing of the arteries. You must be able to manage a recovery period that can last six months or more.
Depending on the severity, there are a range of surgical treatments that can be used:
With a cheilectomy, there is a risk of numbness along the big toe, a painful scar or an incision that does not heal properly. Arthritis is a progressive problem, and you may have continued pain after the surgery. While most patients do well with a cheilectomy for more than 10 years, some may need additional surgery, such as a fusion. This can occur in 20 to 30 percent of patients with big toe arthritis.
Common complications specific to MTP fusion include poor or delayed bone healing, infection, and stiffness in neighboring joints. The metal plate used during surgery can sometimes cause irritation. In this case it can be removed after the bone has healed. Finally, scarring within the joint can limit neighboring tendons.
One of the most frequent complications of first MTP joint interposition arthroplasty is failure to relieve pain or preserve motion. Another complication is rejection of the tissue placed in the gap, which may require further surgery. Other complications can include pain at the base of the second toe, delayed wound healing, recurrent deformity, bony overgrowth, disintegration of bone around the graft, implant displacement, instability of the joint and injury to the nerves of the big toe.
Joint Replacement complications include failure of the implant and need for further surgery. These can be associated with death of the bone due to interruption of the blood supply, transfer pain to the second toe, recurrent deformity, bony overgrowth, disintegration of bone around the implant, implant displacement, instability of the joint, and injury to the nerves of the big toe.
With Resection Arthroplasty, patients may suffer from a “floppy” big toe that lacks power and function. This “floppiness” may bother patients during even minor activities such as dancing. Other complications include delayed wound healing, recurrent deformity, bony overgrowth, disintegration of bone, instability of the joint, and injury to the nerves of the big toe.