Mr Tristan Barton
Consultant Orthopaedic Surgeon
All aspects of foot and ankle surgery including complex hindfoot reconstruction, Arthroscopic (keyhole) surgery, Forefoot reconstruction including bunion surgery
View full profileBig toe arthritis surgery
Osteoarthritis can occur as a result of general wear and tear of the cartilage in your joints. Cartilage covers the joint at the base of your big toe like a carpet, and protects the joint as you move. When this cartilage starts to wear out, it can result in pain and stiffness. If osteoarthritis develops in the joint at the base of your big toe, you may notice some swelling around the joint, and it may become increasingly difficult to walk. If a patient comes to see me with these symptoms, I have two main priorities:
- Address your pain
- Improve your quality of life by enabling you to be more mobile and helping you to regain function.
There are various treatments available, and I tend to start off non-operatively. We will initially discuss your foot and the effect this is having on your mobility. This will be followed by an examination and obtaining further x-rays of your foot if needed. These x-rays will confirm and indicate the severity of any osteoarthritis, and we can then discuss all the treatment options available to you.
Simple things you can do to help your pain are take simple pain relief medication and wear shoes with stiff soles. A stiffer shoe will restrict the amount your big toe bends, and greatly help the pain. If your pain hasn’t responded to simple measures then a steroid injection to the joint may be an option. The pros and cons of an injection will be discussed with you. The final option is surgery. This involves fusing (stiffening) the joint. This removes the pain and any bone prominences associated with the joint. Although the joint is stiff, people walk surprisingly normally, and certainly better than before surgery due to the reduction in pain.
What is involved in big toe fusion surgery?
The main aim of surgery is to reduce the pain in the joint. At the same time, I can remove the bone prominences around the joint, and also straighten the toe if needed.
The surgery can be performed with you awake or asleep. If you are awake, you will have an anaesthetic ‘block’ so will feel no pain. The decision as to which anaesthetic you have is entirely yours. Surgery is performed as a day-case procedure, which means that you will have the operation and go home on the same day. If you need to stay overnight, this can be arranged.
The surgery typically takes about 1 hour and involves making an 8cm incision over the inside of your foot over the joint. The joint is exposed and any bony prominences can be removed. The arthritic bone is then removed from the joint, which is then fixed in a straight position with screws and a small plate. The incisions are then stitched up, and a heavy bandage is applied.
After surgery I will give you a special walking shoe that goes over the dressings, and our physiotherapy team will be on hand to help you learn to walk with crutches while the foot begins to heal. Keeping the foot elevated is very important, especially early on, as this helps combat swelling and further pain. You will need to walk on your heel on the side we have operated on for 6 weeks.
I will see you at 2 weeks following surgery. At this time your stitches will be removed, and the foot will be placed in a special plaster shoe by a plaster technician. You will have to continue wearing this special shoe and walk on your heel for another 4 weeks. I will see you again at 6 weeks following surgery and we will get x-rays of your foot. If everything looks as we would expect, we will remove the plaster shoe and you will be able to walk more normally in a loose-fitting pair of shoes.
It does take up to 6 months for all the swelling to settle, and you have to be patient during your recovery as it does take time.
Are there any risks to be aware of?
There are some risks to be aware of with big toe fusion surgery. There will be pain, bruising and swelling after surgery that will settle over the first 6 weeks. Swelling can take up to 6 months to improve. The scars can feel a bit tender and ‘lumpy’. This generally responds well to massage once the wound has completely healed, and bio-oil can be helpful for this. There may be some on-going pain following surgery, but I would expect your symptoms to be much improved.
The main specific risk of fusion surgery is that of the bones not healing together. This occurs in approximately 5% of patients and the risk is far higher in smokers. I would suggest stopping smoking prior to considering any form of fusion surgery. Very occasionally the bones do not heal together and the toe continues to be painful. If this is the case then surgery may need to be repeated.
Why should I book a consultation at Sulis Hospital Bath?
Our dedicated foot and ankle unit at Sulis Hospital Bath is the ideal facility for you if you have been struggling with pain from arthritis of your big toe. Every patient has different needs, and I will tailor your surgery and recovery to your individual requirements.
Alongside a dedicated physiotherapy team to guide you through your recovery and rehabilitation, this level of personalised care extends right through your time with us at Sulis Hospital. Book a consultation with me today and we can discuss all options, both surgical and non-surgical, available to you.