HALLUX RIGIDUS (Big toe arthritis)
This is arthritis of the big toe, which may occur following trauma, after infection, after gout episodes or from inflammatory/osteoarthritis.
Symptoms
There is rigidity of movements of the joint, associated with pain and swelling. As new bone forms (osteophytes) this can cause irritation from rubbing in shoes.
Non-operative management
Analgesics and non-steroidal anti-inflammatory medication may help with the pain and swelling. In the earlier stages of arthritis, a steroid injection into the joint can also be considered.
Modification of footwear can also provide initial relief. A soft shoe for the toe box will relieve pressure from the osteophytes, whilst a stiff-sole or rocker-bottom shoe will relieve the arthritic joint pain by reducing joint movement.
Operative management
In the early stages of arthritis, when the main complaint is pain from the osteophytes rather than generalised arthritic pain, there is an option to just remove the osteophytes (cheilectomy) and preserve the joint.
In more advanced arthritis, a fusion procedure is considered the gold standard in surgical management. With this procedure the joint is prepared, by removing any remaining cartilage tissue and hard (sclerotic bone) and joining the bones on either side of the joint together. This is usually held with either screws, plates or a combination of both. Once healed the joint remains stiff and
therefore the pain resolves as the joint surfaces can no longer rub against each other.
In some cases, particularly in those patients who are relatively sedentary, a silastic joint replacement can be considered, but there is no long-term evidence to support this approach.
Complications
As with any surgery there are potential risks. This will be discussed in more detail during the consultation, however common complications are stiffness, swelling, nerve injury, infection, non-union, under correction and over correction of positions and prothesis loosening.
Recovery
Your foot will be in bandaging and a surgical shoe will be provided to allow you to weight-bear whilst protecting the foot. You will be provided with crutches for support. Elevation, as much as possible, is important in the first few weeks. The bandaging will come down at 2 weeks and dressings changed. If you have had a joint replacement, the surgical shoe can be discarded and replaced with a normal comfortable shoe (often a size up from pre-operative size). For the fusion patients, the surgical shoe will be required for weightbearing for approximately 5-6 weeks. Swelling can be expected to be present for up to 6 months, particularly in the evenings.
With regards to return to work, it is dependent on the amount of weightbearing required. If the work is sedentary and you can keep the foot elevated, then return after 2 weeks is satisfactory. Otherwise, return to work should be expected after 6-8 weeks.