I have a condition the surgeon calls rigid hallux (or maybe it’s the other way around: hallux rigid — I can’t remember). Anyway, it’s some kind of big toe arthritis. I’m looking into the different treatment options. The surgeon is advising I strongly consider a joint replacement. What can you tell me about these — especially how well something like this would hold up with all the walking I do for my job as a mail carrier.

You are probably thinking of a condition called hallux rigidus, a degenerative type of arthritis that affects the large joint at the base of the big toe. The degeneration causes two problems–pain and loss of motion in the metatarsal phalangeal (MTP) joint of the big toe. Without the ability of the MTP to move enough to allow the foot to roll through a full step, walking can become painful and difficult.

Replacing the joint with an artificial joint is one of several treatment options usually recommended for moderately involved joints. (Arthrodesis or fusion still produces better results for patients with severe hallux rigidus). In the joint replacement procedure, one or both of the joint surfaces is removed and replaced with a plastic or metal surface. This procedure may relieve the pain and preserve the joint motion. The major drawback is that the artificial joint probably will not last a lifetime and will require more operations later if it begins to fail.

There are actually several different ways to accomplish a joint replacement. A total joint replacement removes and replaces both sides of the joint. This type of procedure requires a conical stem that sits down inside the toe bones on either side of the joint. The implants can be made of ceramic, titanium, cobalt-chrome, or titanium combined with polyethylene (plastic) parts.

Metatarsal hemiarthroplasty replaces just one side of the joint — between the bone closest to the big toe joint (metatarsal) and the middle phalangeal bone. Limited studies have been done using this approach but patient satisfaction is reportedly high (100 per cent) with no implant failures or need for revision surgery.

There is a need for improved implant designs and materials for joint replacements. Right now, joint replacement is not considered the best approach for everyone with hallux rigidus. Joint replacement is most likely helpful in the case of moderately involved rigid hallux. Problems with subsidence (implant sinks down into the bone), implant loosening, and implant stems poking out through the bone keep this treatment option as second best to arthrodesis (first choice). More research is also needed to find more successful, acceptable nonoperative ways to treat this problem.