Big Toe Arthritis (Hallux Rigidus)
Surgery for big toe arthritis (hallux rigidus)
The first metatarsophalangeal (MTP) joint is at the base of the big toe. It bends as the foot pushes off the ground. Hallux rigidus is arthritis of this joint and typically causes pain, stiffness, reduced upward bending and sometimes a prominent bone spur on top. It should not be confused with hallux valgus (a bunion), in which the big toe deviates towards the lesser toes.
Symptoms and diagnosis
Pain may be prominent during walking uphill, running, squatting or wearing shoes that press on a dorsal bump. As disease advances, pain can occur throughout the remaining arc of joint movement. Examination includes movement, alignment and the site of pain; weight-bearing X-rays help assess joint-space narrowing, bone spurs and severity.
Treatment without surgery
A stiff or rocker-soled shoe, carbon-fibre insert, activity adjustment, suitable pain relief and a steroid injection into the joint may reduce painful motion. Surgery is considered when symptoms remain intrusive despite reasonable conservative treatment.
Cheilectomy: keeping the joint moving
Cheilectomy removes bone spurs and impinging tissue from the top of the joint. It is usually most appropriate for selected mild to moderate arthritis with dorsal impingement pain and a meaningful amount of preserved joint surface. Its aim is improved comfort and useful motion, not cure of the arthritis. Persistent or progressive cartilage loss may eventually require further surgery, sometimes fusion.
First MTP fusion (arthrodesis)
For more advanced arthritis, fusion is a reliable operation and most fusions heal successfully. The worn cartilage surfaces are prepared and the metatarsal and proximal phalanx are fixed together using screws and/or a plate until bone union occurs. This removes painful movement at the first MTP joint but permanently eliminates joint bending there. The final position is important for footwear, gait and comfort. Many patients can walk, cycle and undertake recreation after healing, although some high-demand activities and high-heeled shoes may be difficult.
Are there other procedures?
Osteotomies, interposition procedures and implants may be considered for selected patients, but these are not interchangeable with cheilectomy and fusion. Patient selection, remaining cartilage, deformity and implant-specific limitations matter. Mr Senthi will discuss the options that suit your foot.
Recovery
Following cheilectomy, some patients can walk in a protective shoe relatively early and start toe movement exercises as advised. Fusion generally requires longer protection while the bones heal; a stiff post-operative shoe or boot is commonly worn for about 6 weeks, often with weight taken through the heel. Most people can drive again about 6 weeks after a big toe fusion. Swelling may continue for months. Actual return-to-driving and work advice depends on side, footwear/boot, analgesic effects and capacity to control the vehicle, not a fixed number of weeks alone. See When can I drive after foot or ankle surgery? Contact the rooms promptly if you develop a fever, increasing wound redness or discharge, severe worsening pain or calf swelling after surgery; call 111 for chest pain or breathlessness.
Risks
Risks include infection, wound complications, scar sensitivity, nerve symptoms, persistent pain and stiffness. Cheilectomy may not relieve pain from advanced arthritis, and arthritis can progress. Fusion risks include nonunion, malposition, hardware irritation and pain under the ball of the foot (transfer metatarsalgia) or arthritis in the toe’s other joint. Smoking and other medical factors may impair healing.
Common questions
Is cheilectomy a cure for big toe arthritis?
No. It removes impinging bone and may improve motion and pain in appropriately selected patients.
Does fusion mean the whole toe is stiff?
The first MTP joint is fixed; the interphalangeal joint and other parts of the foot still move.
Can I run after fusion?
Some people do, but performance and comfort vary and some demanding activities remain difficult.
Is this the same as bunion surgery?
No. Bunion surgery addresses hallux valgus deformity, although combined deformity and arthritis sometimes influence the operation chosen.
Seeking specialist advice
The decision between cheilectomy and fusion is based on symptoms, pain pattern, joint damage and personal priorities, not X-ray appearance alone.
Related pages: Bunion surgery, Driving after surgery.