Surgical Correction of Arthritis in the Big Joint

Hallux limitus/rigidus is a problem with the big toe joint where movement is limited or nonexistent. The limitation of the big toe joint can cause extreme pain and swelling for the patient. Trauma is the typical cause of this problem but it can also be a result of autoimmune disorders and poor biomechanics of the foot. Trauma can cause the joint space to become arthritic to the point where even the slightest motion of the joint can cause pain.

Diagnosis of the problem is accomplished by the doctor performing a physical exam and also looking at the structure of the big toe joint by utilizing X-ray. The X-ray will show the extent of the joint pathology so that proper treatment can be established.

Surgical intervention is only considered if the severity of symptoms warrants correction. If the patient complains of severe pain consistently then surgery would be considered only after conservative therapy fails. There are a few surgical procedures that can be considered to fix this problem.

The minimally invasive approach, cheilectomy, total joint replacement, and a big toe joint fusion. The minimally invasive approach is reserved for mild to moderate arthritic changes of the big toe joint. A small 2mm incision is made adjacent to the arthritic changes. A bone burr is then introduced into the incision site and is used to smooth out any arthritic changes to the joint. The shaved bone allows for better movement of the toe and can decrease symptoms.

A cheilectomy is a more aggressive procedure that requires a larger opening of the skin. A four centimeter incision is made on top of the arthritic big toe joint. A bone saw is then used to resect the arthritic joint out to allow for movement of the joint. This procedure will need more healing time but walking is allowed the same day of surgery.

A total joint replacement of the big toe is more aggressive than the cheilectomy because it requires extra hardware to be implanted. A silastic or silicone implant that is flexible can be implanted into the big toe joint to allow for proper motion. The removal of all arthritic bone is required in order to be able to implant the device properly. This procedure takes approximately 4-6 weeks of healing time.

Joint fusion is the most definitive procedure since stopping motion of the big toe joint can alleviate all symptoms. Fusion of the big toe joint requires removal of all arthritic bone and allowing the bones to fuse together. This fusion requires six weeks of non-weight bearing to heal.

All these surgical options have certain indications which is based on the severity of the big toe joint. The higher the severity of symptoms the more aggressive the surgical procedure. The doctor will discuss all these options with the patient and together they will make the treatment of choice.

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