How is the Surgery Performed?

If you have an arthritic big toe, then several different operations are possible, but the choice depends on how much pain you have, how much you want to keep movement, and how much risk you are willing to accept from surgery.

If you have pain, but there is no visible sign of arthritis or only very early signs of arthritis on an xray, then a camera examination of the joint through keyhole surgery may confirm the diagnosis and allow treatment.

If there are spurs on the bones around the joint, then the joint movement and pain may be relieved with a trimming of the spurs. This is called cheilectomy.

If the joint is completely worn out, then you may choose to have the joint fused or replaced.

Pain arises in the joint from rubbing of two worn surfaces. Fusion aims to join the bones together surgically so that there is no movement and hence no pain. This is the gold standard operation as it is the most reliable. However, movement in the joint is lost permanently. It is still perfectly possible to walk long distances without any problems.

Replacement of the joint aims to maintain movement of the joint - for sports and recreation. This is less reliable for pain relief, and if pain persists to a level that interferes with day to day activities, then a fusion operation is all that is possible. Joint replacements in the foot are not as advanced and reliable as joint replacements in the hip or knee, and should not be thought of as equivalent.

The choice of fusion or replacement hinges on the advantages and disadvantages of each and what your own requirements are from surgery. Fusion is the most reliable for pain relief, and does not lead to an abnormal walking pattern.

Often, surgery is required for hammer toes or metatarsalgia if this exists, and it will be performed at the same time.

Surgery is carried out under general anaesthetic, but can be carried out with local anaesthetic injections behind the knee or around the ankle. The injections are normally given while you are asleep for your comfort. They can give good pain relief for the first day after the operation. You can go home the same day in the evening.

Risks of Surgery

Bleeding, infection, poor bone healing, poor skin healing, injury to tendons, injury to nerves, recurrence, and a need for further surgery.

There is a small risk of blood clots in the legs or lungs (DVT and PE), and there are also risks from anaesthesia - the process of being put to sleep for your operation.

Risks of Anaesthesia

The injection behind your knee is given using an ultrasound machine to guide the needle. There is a less than 1% chance of injury to the nerve. General anaesthetic also carries risks. These risks are proportional to your general health. You will need to be assessed for your fitness for surgery and an Anaesthetist will be able to advise you on your individual risk.

big toe joint arthritis



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