Big toe fusion
Big toe fusion is a long established and very effective treatment for advanced arthritis in the big toe (hallux valgus). However big toe fusion should only be considered after more conservative treatments have been tried or the condition is considered too advanced for other options.
Your big toes bear a great deal of pressure as you walk, bend down, climb up and even stand up.
A common problem which affects the big toe is called hallux rigidus. ‘Hallux’ is the Greek word for big toe and ‘rigidus’ indicates the joint is stiff and inflexible. Hallux rigidus is a form of osteoarthritis which occurs when the cartilage within the joint wears out.
Hallux rigidus is a relatively common problem which often responds to more conservative treatments. However, in more advanced cases, fusion surgery may be considered.
Do I need big toe fusion treatment?
Fusion does result in stiffness within the big toe joint and limits shoe choice to some extent. Therefore it is only considered if arthritis is advanced and has caused extensive damage to the joint. Big toe fusion is also undertaken for some bunions and if the big toe joint is floppy, weak or painful, usually as a result of previous surgery.
The stiffness in the big toe joint can change the way you walk, but most people find this does not cause any problems and are able to resume their normal activities. You will not be able to wear a heel of more than one inch after big toe fusion surgery. Some people require orthotic devices or shoes with a special ‘rocker’ bottom to help push the foot forward.
For most, accommodating these changes is worthwhile as the main goal is to eradicate pain. However it is important to consider these factors when thinking about fusion surgery.
How does the procedure work?
An incision is made along the side of the toe and the worn surfaces of the joint are cut away. The two bones which make up the joint are fixed together using screws. During the next four to six weeks, the joint will knit or fuse into a single, painless structure.
How long will it take to recover?
You will normally spend a night in hospital, although it is possible for some people to return home on the same day. Your joint will feel quite sore and swollen immediately afterwards, although painkillers can relieve the discomfort and this will settle down.
You must not weight bear at all for the first two weeks while the bones are fusing together. Your foot will be placed in a bandage and you will wear special shoes which prevent you from placing any weight on the front of your foot. You must wear these shoes as you start to walk, from two weeks post surgery.
From about six weeks you should be able to wear normal footwear again.
Our specialists at London Foot and Ankle Centre are highly experienced in big toe fusion and other more conservative treatments for arthritis in the big toe.