Hallux rigidus is a condition in which the big toe becomes stiff, painful and swollen due to arthritis. This is caused by wear on the joint at the base of the toe, known as the metatarsophalangeal, or MTP, joint. Hallux rigidus surgery is generally used to treat the condition if non-surgical methods have failed. Options for big toe surgery include cutting away spurs of bone which may have formed at the MTP joint, removing further bone to increase the range of movement, joint fusing and joint replacement. The type of hallux rigidus surgery chosen depends on the severity of the condition and the age and activity level of the patient.
Arthritis is more likely to affect the MTP joint than any other part of the foot. Damage to the cartilage covering the surfaces of the joint is associated with inflammation and the formation of outgrowths of bone, known as spurs. These spurs can prevent the toe from bending normally, making walking difficult and causing pain in the upper part of the MTP joint. A lump may be seen on top of the toe, and the joint as a whole may be swollen. Pain is more likely to occur during activity, especially when the toe bends as the foot is pushing off from the ground.
Non-surgical options for hallux rigidus treatment include painkillers, anti-inflammatory drugs and modified footwear. When these have failed to work, but the condition is relatively mild, a type of hallux rigidus surgery known as cheilectomy may be carried out. This involves removing the spurs of bone from the joint. It is often combined with another procedure called a proximal phalanx osteotomy, where a wedge of bone is cut from the big toe to allow it to bend more effectively. There are few complications, and most patients benefit from the operation.
In cases where arthritis is more severe, another type of hallux rigidus surgery, known as arthrodesis, may be used to create a fused joint. The damaged cartilage is cut away from the MTP joint and the surfaces of the bones are fixed together using metal plates, screws or pins. After being fixed, the bones grow together and unite, resulting in a fused big toe. This type of foot surgery is sometimes used when other methods have failed, and the result is usually very stable, although the joint becomes less mobile.
For patients who are older or less active and who have severe arthritis, hallux rigidus surgery may involve replacing the MTP joint with an artificial version made of metal. Replacement may be beneficial in cases where fusion would place strain on another arthritic joint nearby. Research is still ongoing into the long-term success of joint replacement, but some patients have experienced a positive outcome lasting for a number of years.
