I am concerned about stiffness in the first joint at the base of the big toe

What treatments are available?

Arthritis commonly affects the metatarsophalangeal (MTP) joint at the base of the big toe. The joint may become predominantly stiff (hallux rigidus). As with any arthritis, this condition can be treated without an operation by avoiding activities that make the symptoms worse. For example, ladies avoiding high heels will reduce the symptoms. Anti-inflammatory medications and gels can also help, as can supplements such as glucosamine and cod-liver oil in the early stages of the problem. Stiffening the sole of the shoe may also improve symptoms although the effects are often short-lived.

What sort of operations could I have?

Cheilectomy of first MTP joint

What is a cheilectomy?
This is an operation to remove the extra bump of bone on the top and sides of the big toe. It increases joint movement and is successful in reducing symptoms in 80% of patients with less severe arthritis. If cheilectomy fails, it is possible to perform a fusion at a later date. The recovery from cheilectomy is quicker than the recovery from fusion. Over the first two weeks you will be in a stiff soled shoe to allow the skin to heal. After this you will be advised on exercises to start the joint moving. Performing these exercises early and regularly will help you to get the best possible result from your surgery.

Fusion of the first MTP joint

What is a fusion?
A fusion is an operation where the bone at the base of the toe (the metatarsal bone) is fused to the toe bone (phalanx) producing a stiff joint. Any bony bump is usually trimmed off at the same time. The operation aims to realign the great toe and get rid of the pain. It usually maintains strength of the great toe and reduces pain but movement is lost. Because the operation involves holding raw bone edges together while they heal, screws and sometimes a plate, are usually used for initial stability. The foot is usually protected in a post-operative shoe or cast. The hardware may (rarely) need to be removed at a later date if it causes problems.

Replacement of first MTP joint

Toe joint replacement surgery is rarely done, as it is not suitable for the majority of patients. Recent research has shown that the results are not as predictable as those of fusion of the metatarsophalangeal joint.

What happens following an MTPJ operation?