Hallux Rigidus

Hallux rigidus, also referred to as ‘hallux limitus’ is the most common type of osteoarthritis that affects the foot. Our specialist Dr Andrew Knox has published original research on this condition in the Journal of the American Podiatric Medical Association (JAPMA), where he concluded that the strongest risk factor for this problem developing was isolated trauma to the big toe joint. This condition can occur in one or both feet and is typically associated with pain in the big toe joint upon movement. Early specialist diagnosis and treatment is warranted for this condition because research shows that the condition is progressive and options for intervention become less favourable with duration of the problem.

 

At Perth Podiatric Surgery, there are a range of surgical treatments and non-surgical treatments which we provide for hallux rigidus. In early stages where there is limited cartilage wear, treatments we provide at our practice often include custom-made orthotics, footwear recommendations, and imaging-guided cortisone or Durolane injections. These treatments can help to produce pain relief and restore function if employed early. In many patients we see however, initial specialist assessment is often delayed and clear bony changes exist within the joint that are more amenable to surgical treatment.

 

There are 3 common surgical procedures we perform at Perth Podiatric Surgery for hallux rigidus, which can provide pain relief at different stages of the condition development.

  1. Ostectomy

This procedure is performed for grade 1 hallux rigidus and involves removal of bony spurs from the top of the big toe joint surface. It is generally performed for patients who experience pain upon forced extension of their toe and do not have significant cartilage wear present on their scans. The procedure helps to free the joint of any impingement during movement is reasonably straightforward to recover from, involving a short period of immobilisation in a post-operative sandal followed by early range of motion and rehab exercises.

 

  1. Cheilectomy +/- Cartiva (Synthetic Cartilage Graft)

The cheilectomy procedure is a step-up from an ostectomy and involves a more aggressive approach to removal of spurring from the big toe joint, and mobilisation of the soft-tissues around the joint which may have become stiff such as the sesamoid bones. The procedure is often performed in conjunction with grafting of synthetic cartilage (Cartiva) into the metatarsal bone which is done to replace areas of significant cartilage wear on the joint surface. The net effect of this procedure is that the toe is now freed up to move without the impingement of bony spurs, and the Cartiva cartilage graft provides a buffer between the two joint surfaces to prevent bone-on-bone contact.

Most patients who undergo this procedure obtain an improvement in pain and function overall within just a few months of surgery. Dr Knox was the first podiatric surgeon to perform Cartiva cartilage grafting in WA and due to the success we have experienced with this procedure, it has become one of our primary service offerings in Perth. The longevity of the procedure largely depends on the extent of the arthritis present in the joint pre-operatively. In cases of severe arthritis, the chance of experiencing recurrent joint pain over time is high and these patients may be better suited to a fusion procedure. However the cheilectomy procedure +/- Cartiva is still suitable as a primary treatment choice for most patients with hallux rigidus. For further information on the Cartiva procedure in Perth, please refer to our website dedicated to this unique approach: https://www.1300keyhole.com/cartiva


  1. 1st Metatarsophalangeal Joint Fusion

First metatarsophalangeal joint fusion is a definitive treatment approach to the treatment of hallux rigidus. It is usually considered for patients that have moderate to severe arthritis of the big toe joint and works well as a salvage option for patients who require revision for a failed prior procedure. In 1st MTPJ fusion, the remaining cartilage is removed from the big toe joint and a low-profile titanium plate and screws are used to keep the joint permanently rigid. This procedure may sound drastic compared with the other approaches above, however the procedure can provide a definitive answer for patients who have struggled with the pain from this condition for many years – leaving them a straight, painless toe.

After the site has healed, patients can return to normal footwear and function. Impact exercise such as jogging is possible. In fact, Leighton Hewitt played out most of his professional tennis career with a fused big toe! Patients are still able to bend and move their end toe joint after surgery, it is just the joint at the base that remains stiff/solid. In most patients who have this procedure performed however, they generally do not have much movement available at the base joint prior to surgery so this is not a great concern. The procedure takes 2-3 months for most patients to recover from, and requires a period of immobilisation in a post-operative sandal, followed by structured rehabilitation exercises.

Please note:

This website is intended for general information purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. For more information, follow the link to make an appointment to see our specialist podiatric surgeons Dr. Andrew Knox & Dr Burke Hugo.