What is hallux rigidus?

Hallux rigidus is arthritis of the main joint of the big toe in the ball of the foot. It is a wearing out of the joint surfaces. The commonest problem is pain and stiffness in the big toe joint. A bony bump may also develop on top of the joint which may rub on your shoes. See X-ray of hallux rigidus below.

Xray showing hallux rigidus

 

What are the treatment options?

 As with arthritis of any joint, avoiding those activities which cause the symptoms is one option. Anti-inflammatory medications and gels may also help. Non-surgical treatment will not cure your arthritis but may help reduce your symptoms. These include footwear changes, insoles and joint injections.

If non-surgical treatment does not work, I may recommend you to have surgery to relieve your pain. There are several procedures (cheilectomy, fusion or Cartiva) which may be considered for this condition. I will discuss these with you along with the benefits of one type of treatment over the other.

 

What is the Cartiva implant?

Cartiva Synthetic Cartilage Implant is a gel-like implant that is designed to replace the damaged cartilage surface. It is made from polyvinyl alcohol, a material that has been used in a number of medical device applications for more than 20 years. The gel material mimics the quality and density of bone, eliminating the problematic side effects of metal implants, which can damage the bone over time.

Cartiva implant

 

What does surgery involve?

This procedure is usually performed as a day case. It is normally performed under general anaesthetic and frequently combined with a local anaesthetic block for pain relief. 

 

A small incision (4-5 cm) is made to expose the joint. After removing any bone spurs, a small hole (1 cm diameter) is drilled into the damaged cartilage on the metatarsal head. The Cartiva implant is then press-fitted into the hole. This acts as a joint spacer, decreasing bone-on-bone contact responsible for arthritic pain. See X-ray below showing Cartiva in joint.

The skin is closed using stitches and a bulky dressing is applied. Your foot will be protected in an orthopaedic shoe for 2 to 3 weeks. You will be allowed to walk on the operated foot. It is important to keep the foot elevated as much as possible especially for the first 3 days.

Xray with Cartiva implanted

 

Aftercare and FAQs

You will usually be able to go home when you feel ready. You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours. You will be followed-up in clinic 12 to 14 days after surgery to check the wound and reduce the foot dressing.

Wound care – The bulky dressing should be kept clean and dry until your clinic appointment.

Walking - You will be able to walk on the day of your surgery unless advised otherwise.  You may mobilise freely around the house but long walks or standing for long periods should be avoided. You may need to use a stick or crutches for a few days.

Work - If you have a sedentary job you should be able to return to work within 2 weeks. If your job is physical, you may need to stay off work for at least 4 weeks.

Driving - You will not be able to drive for 2 to 3 weeks following surgery. However, if you drive an Automatic and it was your LEFT foot that was operated on; then you may start short drives 2 days following surgery. It is advisable to check the terms of your car insurance to ensure your cover is valid, as some policies state that you must not drive for a specific time period after an operation.

 

Flying after surgery - It is generally recommended to wait at least four to six weeks to fly after any lower limb surgery. It may be possible to fly on short-haul or domestic flights at an earlier time, but you should always check with your GP or surgeon. Always consult your doctor, your health insurance provider and the airline you are flying with before making your flight reservation.

 

What are the surgical risks?

  • Infection - there is a small risk of infection with all surgery.

  • Swelling - this is quite common. In some people the swelling reduces within a matter of weeks and in others could take a few months. 

  • Deep Vein Thrombosis - also known as Venous Thromboembolism (VTE), this is a rare complication of foot surgery.

  • Nerve damage – this may leave you with numbness or a sensitive scar

  • Implant wear - this may lead to your pain recurring and the need to convert to a fusion

It is beyond the scope of this document to list rarer risks (less than one in a thousand) but I will be very happy to discuss any worries about specific concerns and also about any family history or your past health problems. If there is anything you do not understand or if you have any questions or concerns, please feel free to discuss them with me.

Mr Dev Mahadevan
Consultant Foot and Ankle Surgeon

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