Hallux Rigidus is a term used to describe wear and tear (arthritis) in the joint at the base of the big toe.

Over many years, the joint forms new bone, to increase its surface area, which contributes to the bony swelling felt around the joint. This also causes the joint to be stiff.

It is usually symptomatic due to pain on walking, rubbing of the bony swelling against shoes and stiffness of the joint.

Why do you need surgery?

Before being offered surgery, you should have tried other treatment in the form of wide-box shoe-wear, padding the swelling and stiff forefoot insoles.

This operation is offered to you if you continue to have symptoms despite trying the above measures and after you have been examined and counseled.

Three types of procedures are used for Hallux Rigidus:

Cheilectomy of the 1st MTP joint

What does the operation involve?

The operation is done as a day case but come prepared in case you need to stay overnight. The operation is done under a general anaesthetic and a nerve block (which means numbing the nerves of the foot).

The operation involves an incision over the base of the big toe joint.  The extra bump of bone on the top of the big toe is trimmed to free the joint and prevent the two sides of the joint rubbing against each other during walking.

Your post-operative period:

1. •You will have a bandage on your foot
   

2. •You will go home with a surgical sandal on your foot
   

3. •You must keep your foot raised for the first one - two weeks and if necessary afterwards
   

4. •You can put your full weight on your foot when you are comfortable
   

5. •Exercise your big toe as you can to regain joint movement
   

6. •Use crutches if needed
   

7. •The swelling comes and goes and may last for up to three - six months.
   

Your follow-up

1. •At two weeks the dressing is reduced and stitches are removed
   

2. •At six - eight weeks you have a follow-up for x-rays
   

3. •Back into wide fitting shoes at two - six weeks
   

4. •Off work for about two - four weeks
   

5. •No driving for four - six weeks.
   

What are the possible complications?

1. •Ongoing pain
   

2. •Need for further fusion surgery
   

3. •Sensitive or painful scar
   

4. •Big toe permanent numbness
   

5. •Joint stiffness
   

6. •Infection
   

7. •Clots in the leg (DVT)
   

8. •Clots in the lung (PE)
   

9. •Chronic Regional Pain Syndrome
   

Smoking, diabetes, rheumatoid arthritis or being on steroids or blood-thinning medication increases possible risks significantly.

Fusion of the 1st MTP joint

The operation is usually offered in severe cases of arthritis of the big toe MTP joint.

What does the operation involve?

The operation is done as a day case, but come prepared in case you need to stay overnight.

The operation is performed with general anaesthetic and nerve block (which means numbing the nerves of the foot).

The operation involves one incision over the base of the big toe. The abnormal extra bone around the joint is trimmed. The remaining cartilage on the joint surfaces is removed and the joint is fixed using metal staples, screws or a metal plate.

You are given crutches if needed.

example for advanced Hallux Rigidus:

                                  Before                                             After

example for severe stiff painful Hallux Valgus:

                                  Before                                             After

Your post-operative period

1. •You must keep your foot raised for the first two weeks and when necessary afterwards
   

2. •You can put partial weight on your foot using the surgical shoe
   

3. •Use crutches
   

4. •Avoid any bending forces on the big toe
   

5. •The swelling comes and goes and can last for a long period up to six months.
   

Your follow-up

1. •At two weeks the dressing is reduced and stitches are removed
   

2. •At six weeks for x-rays
   

3. •Off work for about six - eight weeks, depending on your job.
   

What are the possible complications?

1. •Infection
   

2. •Ongoing pain
   

3. •Cock-up position of the big toe
   

4. •Failure of bone healing (non-union)
   

5. •Sensitive or painful scar
   

6. •Big toe permanent numbness
   

7. •Clots in the leg (DVT)
   

8. •Clots in the lung (PE)
   

9. •Chronic Regional Pain Syndrome
   

10. •After this operation, walking uphill is usually difficult and some patients require shoe-wear modification.
    

Smoking, diabetes, rheumatoid arthritis or being on steroids or blood thinning medication increases possible risks significantly.

Hemiarthroplasty of 1st MTP joint

What does the operation involve?

The operation is done as a day case, but come prepared in case you need to stay overnight.

The operation is performed under general anaesthetic and nerve block (which means numbing the nerves of the foot).

The operation involves one incision over the base of the big toe. The abnormal extra bone around the joint is trimmed to free the joint. Half of the joint is removed and replaced by a metal button-shaped prosthesis.

You see the physiotherapist after or before your operation and they give you crutches if needed.

                        Before                                                    After

Your post-operative period

1. •You must keep your foot raised for the first two weeks and when necessary afterwards
   

2. •You can put your full weight on your foot
   

3. •Use crutches if needed
   

4. •Exercise big toe when dressings are removed
   

5. •The swelling may last for up to six months.
   

Your follow-up

1. •Nurse-led clinic at two weeks to reduce dressing and remove stitches
   

2. •Consultant clinic at six weeks for x-rays
   

3. •Off work for up to six weeks, depending on jour job
   

4. •No driving for up to six - eight weeks.
   

What are the possible complications?

1. •Infection
   

2. •Ongoing pain
   

3. •Loosening of the implant
   

4. •Need for further revision surgery
   

5. •Sensitive or painful scar
   

6. •Big toe permanent numbness
   

7. •Joint stiffness
   

8. •Clots in the leg (DVT)
   

9. •Clots in the lung (PE)
   

10. •Chronic Regional Pain Syndrome
    

Smoking, diabetes, rheumatoid arthritis or being on steroids or blood-thinning medication increases possible risks significantly.