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 information sheet.
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 healing.
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 monitoring.
A large dressing will be placed on your foot and you will be given a special shoe and crutches. You should avoid wearing tight clothing.
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 re-dressed.
- 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 shoes.
- The foot will still be quite swollen especially at the end of the day.
- You may return to work but may need longer if you have an active job.
- You may return to driving if you can perform an emergency stop. You must check with your insurance company before driving again.
- Whilst normal activity will be resumed, sport should be avoided.
Between 8-12 weeks after surgery
- The foot should continue to improve and begin to feel normal again.
- There will be less swelling.
- Sport can be considered after 3 months depending on your recovery.
Six months after surgery
- You will have a final review between 3-6 months following surgery.
- 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 delayed.