Degenerative arthritis that affects the large joint at the base of the big toe is referred to as Hallux rigidus. Degenerative arthritis can result from wear and tear on the joint surface over time. The condition may follow an injury to the joint such as you described.
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. Nonsurgical management is always advised first and may consist of nonsteroidal antiinflammatory medications to reduce pain and swelling, shoe adaptations, and changes in activities.
When conservative care doesn’t help, surgery may be the next step. There are three main surgical choices: cheilectomy, arthrodesis (fusion), and joint replacement. Surgery has helped many people with this problem with a reported rate of patient satisfaction of up to 95 per cent.
A cheilectomy is a procedure to remove the bone spurs at the top of the joint so that they don’t bump together when the toe extends. This allows the toe to bend better and reduces the amount of pain while walking. To perform a cheilectomy, an incision is made along the top of the joint. The bone spurs that are blocking the joint from extending are identified and removed from both the bones that make up the joint. A little extra bone may be taken off to ensure that nothing rubs when the hallux is raised. The skin is closed and allowed to heal.
Cheilectomy will allow you to keep your joint motion. Though it has been observed that maintaining and even increasing motion does not always mean your ability to walk normally is restored. Studies show that pain relief and even positive patient satisfaction are not directly linked with return to normal joint motion. The reason(s) for this remain unknown at this time.
In about one-third of all cases treated with cheilectomy, there is a return of the extra bone growth that form bone spurs. It seems that less active (often older) patients may have better results compared with younger, more active adults. This is especially true when looking at results for patients who are engaged in high-level sports activities.
Cheilectomy may not be the end of the line in terms of treatment for some patients. Arthrodesis (joint fusion) may be required in time. This is especially true for patients with severe hallux rigidus. There are other surgical procedures that are slight variations of these three approaches. For example, cheilectomy may be combined with a phalangeal osteotomy. The surgeon removes a wedge-shaped piece of bone from the middle toe bone in order to take pressure off the joint. Some patients can be successfully treated with just the osteotomy procedure.
Another alternative approach (more for the younger patient) is the interpositional arthroplasty. In this procedure, the surgeon removes the base of the toe bone (phalange) and places a “spacer” in the hole left. The spacer is made up of a rolled up piece of tendon. The surgeon may have to release the tendon that inserts into the base of the phalange for this to work best. This decision is made at the time of the surgery.
After surgery, it will take about eight weeks before the bones and soft tissues are well healed. You may be placed in a wooden-soled shoe or a cast during this period to protect the bones while they heal. You will probably need crutches briefly. A physical therapist may be consulted to help you learn to use your crutches.
The incision is protected with a bandage or dressing for about one week after surgery. The stitches are generally removed in 10 to 14 days. However, if your surgeon used sutures that dissolve, you won’t need to have the stitches taken out.