Big toe problems
The main joint of your big toe can cause you trouble in several ways. A bunion can develop causing a prominence to the side of the joint (click here for more information on bunions).
Some people develop stiffness in the joint. This can be associated with pain, particularly when trying to bend the toe with activities such as running. A prominence may be felt (or even seen) on the top of the joint and this can also cause rubbing on trainers and shoes. Trying different types of footwear or modifying activity levels may help alleviate the problem. For a few people, however, more invasive treatment may be needed. This can be in the form of steroid injections or surgery. Surgery is usually carried out to remove the bony prominence and allow the joint to move more freely.
If the main issue in the joint is arthritis (as determined by x-rays) then steroid injections may still be offered. If surgery is needed in these cases it falls into two main categories – fusion or replacement. Big toe joint fusion is surgery to stop the joint moving completely. In cases when this is recommended there would usually already be very little movement in the joint but with pain. We would therefore be aiming to convert a stiff and painful joint into one that is stiff but largely pain free. Specially designed metal plates and screws would be used to hold the joint still after removing the damaged joint lining.
In some cases a replacement may be an option. Again, the focus is on relieving pain but this time with the added potential advantage of maintaining some movement of the joint. Once the damaged joint lining is removed, a silastic (plastic) hinge is inserted between the two bone ends to allow movement.
Most surgery to the big toe would be carried out under a general anaesthetic (with you asleep) and in almost all cases you will go home the same day. You will be able to walk straight away and will be given a stiff soled sandal to wear over the bandages. You will be encouraged to rest as much as possible for the first two weeks in order to allow the wound to heal before the stitches are removed. If a fusion procedure is performed you will be able to start using your own shoes at around six weeks post surgery. For replacement surgery or bone removal, this is likely to be around 2-3 weeks. Swelling is common and can last for a few months in some cases.
During your consultation the most appropriate of the above treatments will be discussed.