Hallux Rigidus (Arthritis) Surgery
Your specialist has diagnosed that you have a arthritis of your
big toe joint, technically called Hallux Rigidus. In order to
relieve your pain you require an operation. An operation will be
recommended if your level of pain has not improved with
conservative measures or the degree of deformity means that this is
unlikely. Answers to common questions are outlined in this
Before undertaking surgery you should be certain that
conservative (non surgical) options have been considered and that
you understand the implications and complications of the proposed
surgery. If you have any concerns, please discuss these with your
specialist before the operation date.
How will you relieve the pain?
Arthritis is a degenerative condition of the joint with loss of
cartilage and excess bone formation. Surgery cannot stop this
process but can reduce the bony prominence and try to improve
function, thus reduce pain. If the excess bone is the main problem,
removal of this bone may be sufficient. However, if there is joint
pain further surgery is required. By cutting and realigning the
bone in either the base of the big toe or the bone that forms the
joint with the toe (metatarsal), stress to the joint can be
relieved. The advantage of these procedures are that they leave the
joint intact with further options for the future. The metatarsal
surgery has a longer recovery and the potential to increase
pressure onto the adjacent metatarsals.
If the disease is severe, removal of the bone in the base of the
big toe (Keller's arthroplasty) is often necessary. Whilst this
provides good pain relief and a relatively quick recovery, the toe
shortens and loses strength. Artificial joints are an alternative
although these are generally used for older less active patients
and may require removal at a later date. The final option is to
remove the remaining cartilage and allow the joint to fuse
(arthrodesis). Whilst this relieves joint pain, the toe is fixed in
one position and limits shoe choice. All of these involve cutting
the bone with the repositioning of the toe or metatarsal and
arthrodesis of the joint requiring screw or wire fixation to allow
What will happen in the operation?
The operation will be performed under local anaesthetic, so you
are awake and can eat normally up until the time of your operation.
The injection is usually at the ankle and is generally more
comfortable than a dental injection. The operation will last for
approximately one hour but you will be at the hospital for much
longer to allow sufficient preparation and post operative
A large dressing will be placed on your foot and you will be
given a special shoe and crutches. You should avoid wearing tight
What are the advantages of this operation?
- Less prominent bone
- Less discomfort
- Easier walking
Whilst it cannot be guaranteed that your toe will be perfectly
straight or completely pain free, it is highly likely that your toe
will be much improved.
!I have heard it is a very painful operation
Advances in techniques, local anaesthetics and pain killers now
mean that patients have a high level of success with much less
pain. Generally, the pain is worst the first night, sometimes
extending to the second night following the operation. It is
difficult to predict how much pain an individual patient will
experience as some patients have no pain whilst others have a lot
of discomfort during this period. However, if you do as you are
advised, this is kept to a minimum.
!What are the complications?
Every effort is made to minimise the risk of complications.
However, some specific complications may occur, such as:
- The toe may still be stiff after the operation.
- Further arthritic changes are likely
- Increased pressure beneath the ball of the foot can occur after
a Keller's arthroplasty or re-positioning of the bones
!How long will it take me to recover?
First 2-3 days
- This is the worse time for pain but you will be given pain
killers to help. You must rest completely for 4 days.
One week after surgery
- You will need to attend for your foot to be checked and
- You may start to do a little more within pain limits. Pain
means you are doing too much.
Two weeks after surgery
- You must attend again. Stitches will be removed unless they are
on the sole of the foot (these are taken out after 3 weeks).
- You will not need a bandage, probably will not need the
crutches and can get the foot wet.
Between 2-6 weeks after surgery
- The foot starts to return to normal and you can return to
- The foot will still be quite swollen especially at the end of
- You may return to work but may need longer if you have an
- You may return to driving if you can perform an emergency stop.
You must check with your insurance company before driving
- Whilst normal activity will be resumed, sport should be
Between 8-12 weeks after surgery
- The foot should continue to improve and begin to feel normal
- There will be less swelling.
- Sport can be considered after 3 months depending on your
Six months after surgery
- You will have a final review between 3-6 months following
- The swelling should now be slight and you should be getting the
full benefit of surgery.
Twelve months after surgery
- The foot has stopped improving with all healing complete.
Whilst a plaster cast is generally not required, it is necessary
for certain operations. These are usually necessary for 8-12 weeks
and will delay the recovery process.
Please note, if a complication arises, recovery may be