Arthritis of the Big Toe

What is wrong with my foot?

You have developed arthritis of the big toe joint. This is often associated with a bony bump(s) on the side or top of the joint. This bump may have become red and sore and is often called a 'Bunion'.   

Why has this happened?

Arthritis of the big toe joint is fairly common in people over 50. Wearing shoes that are too tight or being flat-footed may also contribute to the formation of a bunion/arthritic joint.

Do I have to have an operation?

Pads, splints, foot orthoses and special shoes can be used to provide comfort but will not cure the arthritis. Pain killers may reduce the pain from the joint. If the bunion or big toe joint is still uncomfortable despite these measures then an operation will usually be recommended.

Hallux Limitus

What will the operation involve?

The operation involves removing the bony bump and a small section from one of the bones to increase the range of movement of the joint. In some people the bone just behind the joint is too long, which can make the arthritis worse. In this situation the bone is slightly shortened by creating a fracture (Youngswick osteotomy). The fracture is held in place with a screw. The surgery can be performed under general or local anaesthetic. The foot will be heavily bandaged after the operation.

How successful is the operation?

85-90% of people are very satisfied with the results of the operation, as they no longer have pain from the bump or arthritic joint. They are then able to wear normal shoes again.

Are there any risks associated with the operation?

As with all operations there are risks associated with the anaesthetic. Occasionally some patients may have complications such as infection, prolonged swelling, or recurrence of the condition.

What will happen after the operation?

The operation is usually day case but you may need to stay overnight in hospital. The Podiatric surgeon will discuss this with you. You will be given a special shoe to wear over your bandages and must wear this whenever you want to walk. The shoe must be worn for 3-4 weeks following a Youngswick osteotomy or 2 with a Cheilectomy. You will need to mobilise the great toe after you come out of the post-operative shoe. You do not need to use crutches. It takes the foot a good 6 months to fully settle down after surgery.

What happens when I leave hospital?

For the first 48 hours you will rest in bed with your legs elevated and should take the painkillers prescribed for you. You will be asked to do some foot exercises during this time. The bandages will be left on for 2-4 weeks. You will be given an appointment in the Orthopaedic and Fracture Clinics to have the bandages removed. You will be able to return to work from 2-8 weeks after the operation, depending on whether you need to stand or walk around a lot. It is recommended not to drive until you come out of the post-operative shoe.

Hallux Rigidus (1st MTP Joint Fusion)

What will the operation involve?

The operation, called a joint fusion, will involve removing the joint surfaces from each side of the big toe joint and then holding the bones together while they knit to become one bone. The bones are held together by screws or a plate, which are buried and not removed unless they cause problems. Sometimes a wire is also used and may sit proud of the skin and this is removed at 4-6 weeks. Following surgery the toe is left slightly shorter than before but should be pain free and straight. The surgery can be performed under general or local anaesthetic. The foot will be heavily bandaged after the operation.

How successful is the operation?

90-95% of people are very satisfied with the results of the operation, as they no longer have pain from the arthritic joint. They are then able to wear normal shoes again, but the height of the shoe heel should not be greater than 1 inch.
 

Are there any risks associated with the operation?

As with all operations there are risks associated with the anaesthetic. Occasionally some patients may have complications such as infection or prolonged swelling. There may be some residual pain in the forefoot. Occasionally the joint may not fuse necessitating a further operation.
 

What will happen after the operation?

The operation is usually day case but you may need to stay overnight in hospital. The Podiatric surgeon will discuss this with you. You will be given special shoes to wear over your bandages and you must wear these whenever you want to walk. The shoes must be worn for 4-6 weeks. You do not need to use crutches. It takes the foot a good 6 months to fully settle down after surgery.
 

What happens when I leave hospital?

For the first 48 hours you will rest in bed with your legs elevated and should take the painkillers prescribed for you. You will be asked to do some foot exercises during this time. The bandages will be left on for 2-6 weeks. You will be given an Outpatients appointment to return to have the bandages removed. You will be able to return to work from 2-8 weeks after the operation, depending on whether you need to stand or walk around a lot for your job. You will not be able to drive until you come out of the post-operative shoe.

Modified Kellers Arthroplasty

What will the operation involve?

The operation, called a Kellers Arthroplasty, will involve removing a piece of bone from the big toe and inserting soft tissue between the two bone ends. The corrected position of the toe is held in place with two wires for 2-4 weeks. The toe is then left slightly shorter and maybe a little weaker than before but should be pain free. The surgery can be performed under general or local anaesthetic. The foot will be heavily bandaged after the operation.

How successful is the operation?

85-90% of people are very satisfied with the results of the operation, as they no longer have pain from the bump or arthritic joint. They are then able to wear normal shoes again.

Are there any risks associated with the operation?

As with all operations there are risks associated with the anaesthetic. Occasionally some patients may have complications such as infection, prolonged swelling, or recurrence of the condition. If the big toe joint is too weak after the surgery there may be some residual pain in the forefoot.

What will happen after the operation?

The operation is usually day case but you may need to stay overnight in hospital. The Podiatric surgeon will discuss this with you. You will be given special shoes to wear over your bandages and you must wear these whenever you want to walk. The shoes must be worn for 2-4 weeks. The wires will be removed at 2-4 weeks. You do not need to use crutches. It takes the foot a good 6 months to fully settle down after surgery.

What happens when I leave hospital?

For the first 48 hours you should rest in bed with your legs elevated and take the painkillers prescribed for you.  You will be asked to do some foot exercises during this time. The bandages will be left on for 2-4 weeks. You will be given an Orthopaedic and Fracture clinic appointment to have the bandages removed.  You will be able to return to work from 2-8 weeks after the operation, depending on whether you need to stand or walk around a lot.  You will not be able to drive until you come out of the post-operative shoe.