Big Toe Arthritis

 

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At a Glance

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Who needs surgery for big toe arthritis? 

The aim of surgery is to relive pain and improve mobility. It may also be to improve foot shape and function. Surgery is only considered for patients who have not responded to simple measures such as pain relief, physiotherapy, podiatry or shoe modifications, People with the following may need surgery for big toe arthritis:

  • Confirmed arthritis with pain that is so severe that it has an impact on your life, such as walking and standing;
  • intermittent or constant pain through the night; or
  • Pain when carrying out weight b earing exercises such as dancing and climbing stairs.
  • Difficulty in getting comfortable shoes.

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What happens during surgery? 

There are a number of options for big toe arthritis. These may include:

  • cheilectomy: removing bone to reshape the foot and improve movement
  • fusion: eradicating all movement by fixing with screws and/or plates
  • replacement: this may be suitable for only a very small group of patients

Before surgery you may be asked to complete a questionnaire so we can measure the outcomes once you have recovered.

Surgery is usually performed under a general or spinal anaesthetic and some form of nerve block. You will need to stay in hospital for several hours or, sometimes, overnight.

Your surgeon will be able to give you further information about the different options, types of surgery and the specific risks and benefits.

Fusion of the big toe joint is the most common procedure offered.

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Risks of foot surgery

As with any surgery, there are associated risks. If you are overweight, smoke or not active, you are at greater of risk of developing complications after surgery and it may take you longer to recover. You may wish to discuss with your GP or health professional what you can improve before surgery.

  • Stiffness or persistent pain in the foot. In very few cases, nerves may be damaged, which could lead to chronic pain that may be worse than the pain before surgery.
  • There is a low risk of developing a blood clot in the leg or deep vein thrombosis (DVT). All patients will be assessed for DVT risk. If you have no other risk factors, we don’t generally recommend further treatment.
  • Infections can occur but are often treated by antibiotics. Occasionally, wounds can become more deeply infected and require further surgery.
  • Rarely, further surgery may be required if a fusion does not join or joins in a poor position.
  • In some cases, a new joint may not be stable, may loosen or wear, and further surgery may be needed to correct it.
  • A small number of patients may require further insoles or help from a podiatrist if the foot becomes unbalanced after surgery.

It is important to remember that most complications are minor and can be easily and successfully treated.

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Benefits of surgery

The outcome of foot surgery is usually good, but it doesn’t mean that everyone who has surgery will be completely pain free.

The main benefits are:

  • Relief of pain and disability, or pain that may be significantly improved.
  • Greater independence.
  • A wider choice of more comfortable shoes.

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How long will I spend in hospital or on treatment after surgery? 

People having big toe surgery will either go home on the same day or spend one night in hospital.

You will be expected to be up and active the day after surgery by completing normal tasks, such as walking, toileting and dressing, but otherwise will need to strictly rest and elevate the foot for 10 to 14 days after surgery.

For the first six weeks after surgery you may be provided with a modified shoe to protect your foot, and walking aids such as crutches to help support you.

You may start driving again after about six weeks, or earlier if you have an automatic car.

Following your surgery, you may be asked to complete post-surgery outcome questionnaires to monitor your progress and improve our knowledge.

It may take up to one year to recover fully from foot surgery, sometimes longer. A very small number of people will continue to experience pain after surgery.

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