Hallux limitus (Arthritis) Surgery
What is hallux limitus surgery?
Hallux rigidus is a form of degenerative arthritis affecting the big toe joint (metatarsophalangeal joint). It causes pain, stiffness, and a reduction in the range of motion in the affected joint. Early on the condition is referre to hallux limitus but as it progressed it becomes known as hallux rigidus. When conservative treatments fail to provide relief, surgery may be recommended.
The type of surgery depends on the severity of the condition and the specific needs of the patient. Dr Abdel Kak performs all three types of surgery for hallux arthritis/hallux rigidus and will assess which is best for each individual presentation.
Cheilectomy – A cheilectomy procedure involves removing bone spurs and arthritis growths around the joint to help alleviate pain and improve the joint motion (dorsiflexion). The removal of the bone spur also helps reducing pressure from tight footwear. This is generally performed in mild-moderate arthritis joints.
Arthrodesis/Fusion – A big toe/1st MTPJ arthrodesis is a procedure in which the joint surfaces of the arthritic joints are removed and the two opposing bone are fused together. This is often referred to as the ‘gold standard’ for this pathology. This is usually performed where Most patients are able return to physical activity including running following this procedure. For these patients, footwear such as high heels are a limitation post operatively.
Interpositional Arthroplasty – This is a newer procedure in which the joint is remodelled by removing the boney spurring. Joints have a protective capsule which surround them keeping the synovial fluid within the joint. This capsule is split and one half of it is interposed into the joint to produce a joint spacer made from living tissue. This avoids bone on bone rubbing and allows for a pain free moving joint. This type of procedure is now well supported in the research with some long term good results.
What is the recovery after a big toe arthritis surgery?
Your big toe arthritis surgery recovery will depend on the initial severity of your arthritis deformity, and the style of surgical treatment performed. In general, patients can walk fully weight-bearing on the day of surgery in a post-operative surgical sandal.
The foot is generally numb with local anaesthetic for 12 – 24 hours and simple
painkillers such as paracetamol and anti-inflammatory medication are taken for the first week or two. Strong painkillers if required are only generally needed in the first week after surgery. Dressings and bandages must stay intact and dry until your 1 and 2 week review where your wounds are checked for healing, and your foot is checked for mobility. Bone healing/union takes approximately 8 weeks at which point you will return to regular walking shoes with a full return to physical activity around 3 months.
What are some of the risk and complications of big toe arthritis surgery?
During the preoperative consultations, Dr Abdel Kak will answer all your questions and discuss the potential risk and complications associated with big toe arthritis (hallux limitus/rigidus) surgery. Although they are usually rare, some of risks and complications include;
- Wound infection – with any surgical procedure, there is a small risk of getting an infection. This occurs in less then 1% of patients and the surgeon will give you antibiotics to treat or help prevent an infection from occurring
- Nerve damage – you may get some numbness around the incision site after the surgery, this usually goes away but in some rare instances this can remain
- Scar formation – in most cases you are left with a faint line which gradually reduces with time. In some instances and skin types the scar can become thickened
- Ongoing pain and stiffness of the joint
- Non/mal union – this is related to the arthrodesis procedure where there is failure of the bones to knit together requiring further surgery
- General risks and complications from any foot surgery which can include; continuous pain, deep vein thrombosis and a possibility of reacting to the anaesthesia (general and local)
Frequently Asked Questions
Hallux limitus/rigidus surgery is usually performed as a day procedure and you are able to go home the same day.
Following the completion of your procedure, you are transferred to a recovery area and your vital signs monitored. You may experience some nausea, pain and be slightly disoriented while the general anaesthesia wears off. The medical staff will ensure you are comfortable, assist you to recommence eating and contact your support person to arrange your pickup. Prior to being discharged, the podiatric surgeon will talk to you briefly going over the procedure, post-operative medications and the post-operative instructions.
During the procedure, a local anaesthetic injection is given makes the foot numb for 12 – 24 hours. Simple painkillers such as paracetamol and an anti-inflammatory medication are taken for the first week or two. Strong painkillers if required are only generally needed in the first week after surgery.
It is important you rest and avoid any unnecessary weight bearing following to allow the bones and soft tissue to heal in the desired positions. Dressings and bandages must stay intact and dry until your 1 and 2 week review where your wounds are checked for healing, and your foot is checked for mobility.
Your foot is usually bandaged and you can weight bear/walk in a post-operative sandal. Walking is kept at a minimum and only for necessity.
Healing, recovery times and work circumstances vary for each individual. Generally, if your job involves predominantly you sitting, you can expect to return to work in 3-4 weeks. However if your job requires you to be more active, walking or long periods of standing then you can expect to be back at work in 8-12 weeks.
No – This is generally not indicated given the lack of mobility, risk of falls and complications occurring following the procedure. The surgeon will review your circumstances and advise if this is best for you.
Following your big toe arthritis surgery, the typical post-operative appointments are:
- 1 week
- The compression bandage is changed and the wound and foot is reviewed
- 2 weeks
- The bandage is removed, the sutures removed and a smaller dressing is applied. You will remain in the post-operative sandal.
- 3-4 weeks
- Light dressing will be applied. You will transition from the post op sandal into a stiff soled, wide fitting jogger.
- For arthrodesis procedures – you will remain in the post-operative sandal until 6-8 weeks.
- 8 weeks
- An x ray will be performed to assess the bone healing and alignment of the joints.
- 12 weeks
- The joint and foot will be assessed for alignment, mobility and pain. You will be generally able to return to most activites at this point
- For fusion/arthrodesis patients – return to physical activity can be slower
The cost of big toe arthritis surgery may vary depending on each individuals requirements varying due to complexity, pathology and necessary treatments. We will provide a full cost disclosure prior to commencing any treatment and/or procedure.
Podiatric Surgery is covered by private health insurance funds, however, the level of health fund rebate depends on the fund and level of cover. It is beneficial to contact your private health insurance to find out your cover or one of administration staff can assist you with the health insurance claims.
Disclaimer: The information provided here is for general educational purposes only. Individual circumstance can differ, please contact Dr Abdel Kak’s rooms to discuss if surgery is appropriate for you.