Big toe arthritis; Hallux Rigidus
What causes hallux rigidus?
Hallux rigidus is osteoarthritis of the main joint of the big toe. People affected experience stiffness and pain. In most cases there is no identifiable cause, it is just due to simple ‘wear and tear’. In some people the arthritis may have been caused by injury (post-traumatic arthritis) or other conditions such as gout. Some people notice a large bony bump on the top of the joint that can rub on footwear and cause pain.
How can hallux rigidus be treated?
A lot of people with hallux rigidus do not have any pain and do not require treatment. People with pain should try non-operative treatments first such as painkillers/ anti-inflammatories, changing their footwear or insoles. Your doctor may also try a steroid injection into the joint to help improve inflammation and pain. In some people these simple measures may not improve pain and surgery may be necessary.
Who can have hallux rigidus surgery?
Before having an operation, your doctor will usually check that you have tried non-surgical treatments and ensure that you are fit enough to have an operation. Before an operation people will have a health assessment to check this. The operation is usually performed under a general or spinal anaesthetic. People who smoke or are diabetic are at increased risk of infection and problems with wound and bone healing. The type of surgery will depend on symptoms, severity of arthritis, deformity of the toe and activity levels/footwear requirements. The options are to just shave off the bony bump (cheilectomy), to remove the joint and stiffen the toe (fusion) or to perform a type of joint replacement. Not all of these options will be suitable for some people. Your doctor will discuss which options are suitable for you.
What does hallux rigidus surgery involve?
Under an anaesthetic a cut is made on the inside of the big toe. The surgeon will then perform the operation that you have agreed on beforehand- cheilectomy, fusion or replacement. After the operation a bandage is applied, and patients are able to walk in a special shoe that allows weight-bearing through the heel. The bandage is removed after 10-14 days to check the wound, but the special shoe needs to be worn for 6 weeks. It is likely that patients will not be able to drive a car for at least 6 weeks after the surgery and some people will need more than 6 weeks off work (depending on their job). At 6 weeks an X-ray is taken and if the bones have healed the patient will be allowed to walk in a flat shoe.
What are the risks of hallux rigidus surgery?
The surgeon will discuss the risks of the operation when taking your consent. There are general complications that can occur with any operation such pain, bleeding, wound problems/ infection, nerve damage and the possible complications of an anaesthetic (the anaesthetist will discuss these with you). Other complications of surgery include: – – A blood clot in the leg (DVT) or lung (PE); the surgeon will assess your risk of this before the operation and may prescribe injections if required – Swelling; swelling of the foot is normal after surgery. In most people the swelling will be reduced enough after 6 weeks to allow wearing of a normal shoe but in some swelling may persist for 6-9 months. Swelling can be improved/avoided by elevating the foot after the operation. – Progression of arthritis; after a simple bump removal (cheilectomy) the arthritis can worsen which may mean another operation is required. – Non-union; after fusion surgery the bones may not join together. This risk is higher in people who smoke. If this happens and if the joint is still painful another operation may be required – Loosening; after joint replacement the prosthesis can loosen and the toe can become painful and stiff. If this happens another operation may be required. – Abnormal pain response; this is known as complex regional pain syndrome and results in excessive pain and loss of function. It is rare.