What is Big Toe Motion Preservation Surgery?
Big toe motion preservation surgery is a procedure employed for the treatment of a stiff big toe.
A stiff big toe, also called hallux rigidus, is a form of degenerative arthritis affecting the joint where the big toe (hallux) attaches to the foot. The toe typically becomes stiff at the base and is sometimes called a “frozen joint”. The big toe joint is called the hallux metatarsophalangeal (MTP) joint. It connects the top of the first foot bone (metatarsal) with the base of the first toe bone (proximal phalanx). Arthritis is the inflammation of joints as a result of degeneration of the smooth cartilage that lines the ends of bones in a joint. This degeneration of cartilage leads to painful rubbing of the bones, swelling, and stiffness in the joints, resulting in restricted movement. Hallux rigidus is also called big toe arthritis.
Treatment options for stiff big toe/big toe arthritis include cheilectomy, soft tissue release, arthrodesis (joint fusion), osteotomy, and excisional arthroplasty. However, all the surgeries often result in lower patient satisfaction levels owing to a reduction in the range of toe movement.
To overcome this, an innovative FDA-approved synthetic cartilage implant (SCI) is being used as a treatment for big toe arthritis/big toe motion preservation surgery. Big toe motion preservation surgery using synthetic cartilage involves removing the damaged sections of the big toe joint and replacing it with an artificial component (synthetic cartilage implant) to relieve pain and restore normal range of motion and function to the big toe and foot. Toe joint replacements utilizing synthetic cartilage have a comparatively high success rate and most patients report 100% pain relief.
Indications for Big Toe Motion Preservation Surgery
Big toe motion preservation surgery with synthetic cartilage is usually indicated for the treatment of hallux rigidus and its symptoms such as:
- Pain and stiffness of the big toe
- Swollen and inflamed toe
- Damaged or worn-out cartilage
- Formation of bone spurs on the big toe joint
- Narrowing of joint space
- Rubbing of the raw bone ends
- Eventual non-flexion of the big toe
- Foot pain interfering with daily activities
- Failure of non-surgical approaches such as physical therapy and medications to provide symptomatic relief
Preparation for Big Toe Motion Preservation Surgery
Preparation for big toe motion preservation surgery may involve the following steps:
- A review of your medical history and a physical examination are performed by your doctor to check for any medical issues that need to be addressed prior to the surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to screen for any abnormalities that could compromise the safety of the surgery.
- You should inform your doctor if you have allergies to medications, anesthesia, or latex. In addition, you should also inform of any medications or supplements you are taking or any conditions you have such as heart or lung disease.
- You may be asked to refrain from certain medications such as blood thinners or aspirin or vitamin/herbal supplements for a week or two prior to the surgery.
- You should refrain from alcohol or tobacco at least a few days before surgery and several weeks after, as it can hinder the healing process.
- You are advised to arrange for someone to drive you home after the surgery.
- Written consent will be obtained from you after the surgery has been explained in detail.
Procedure for Big Toe Motion Preservation Surgery
Big toe motion preservation surgery is usually performed under general anesthesia, and in general, involves the following steps:
- You will be placed in a supine (face-up) position on the procedure table with your foot held in an optimal position to facilitate surgery.
- An incision is made over the big toe and soft tissues are moved away to expose the joint.
- Using special instruments, your surgeon will carefully remove the damaged portions of the joint, and the articulating surfaces of the big toe joint will be prepared for insertion of the synthetic cartilage implant. The synthetic cartilage implant is a tiny cylindrical plug with physical properties similar to those of articular cartilage with a compressible and low friction surface and is placed in between the two sides of the arthritic joint.
- Once the synthetic cartilage implant is confirmed to have been properly fixed in place, your surgeon checks for range of motion to ascertain satisfactory motion preservation at the joint and closes the incision.
- The synthetic cartilage implant provides a smooth surface to the joint, allowing it to move freely, relieving pain and stiffness and improving joint function.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after big toe motion preservation surgery may involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may notice some pain, swelling, and discomfort in the foot area. Pain and anti-inflammatory medications are provided as needed to address these.
- You are advised to keep your foot elevated as much as possible while resting to reduce swelling and pain.
- Your big toe will be secured with a dressing. Assistive devices such as an orthopaedics boot or a cast will be applied for protection and to facilitate healing, along with instructions on restricted weight-bearing.
- You may need to stay in the hospital until you are able to safely walk with a cane, walker, or crutches.
- Instructions on surgical site care and bathing will be provided to keep the surgical site clean and dry.
- Refrain from strenuous activities such as running for the first few months and lifting heavy weights for at least 6 months. A gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol may be recommended to help strengthen foot muscles and optimize foot function.
- Most patients are able to resume their normal activities in a month or two after surgery; however, returning to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- Periodic follow-up appointments will be scheduled to monitor your progress.
Risks and Complications
Big toe motion preservation surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Damage to surrounding tissue
- Pain and discomfort
- Joint stiffness
- Swelling and inflammation
- Thromboembolism or blood clots