Your big toe has a bony enlargement or bone spur across the top of the joint often referred to as a dorsal bunion. The joint is also worn and is referred to as stage 2 or 3 hallux rigidus or osteoarthritis. The big toe joint remains in a straight position but has progressively become stiffer and stiffer over time. It is now very stiff and unable to bend very well during walking. This causes you to walk on the outside of your foot or to walk with your hip turned outwards in an attempt for your body to compensate. The skin and tissue on the bump can become inflamed, swollen, and painful. This joint is already arthritic & is likely to get worse still over time.
Dorsal bunions are most often caused by faulty mechanics of the foot. If the dorsal bunion deformity is hereditary other family members are also likely to have the same problem. That is, a certain foot type makes a person prone to developing arthritis in the big toe joint. Research is pointing to a long first metatarsal and long proximal phalanx of the big toe as a possible cause. One in forty people over 50 is effected, mostly men. Injury is a common cause amongst men, especially if just one foot is involved.
In the early stages pads, rigid footplate, foot orthoses, manipulation under anaesthesia (MAU), extra depth shoes, rocker bottom shoes and avoiding high-heeled shoes can be beneficial. Studies show that MAU relieves pain fort about 6 months. Anti-inflammatory and pain medication can also relieve pain temporarily. A particularly good study revealed that foot problems are a risk factor for falls as you get older. If you’re big toe joint continues to interfere with daily activities and your quality of life, its time to discuss surgical options with your surgeon.
The degree of arthritis affecting your big toe joint is considered mild to moderate. This means that less than 50% of the joint cartilage has been worn away down to the level of bone. This is usually the top 1/2 of the joint. A ‘ V ‘ cut is made to remove the top 1/2 of the arthritic joint. This allows more movement at this previously stiff joint. Unfortunately full range of motion is unlikely to be regained.
It is sometimes difficult to determine the real extent of damage to the joint until it is opened up and visible while in theatre. Both feet can be operated on at the same time, but this does further limit your mobility after surgery.
The bandages will need to be kept dry. You will be given an appointment to return to have the foot redressed in 1 week. You may be able to return to work from 4-6 weeks after the operation, depending on whether you need to stand or walk around a lot for your job. You will not be able to drive until you come out of the post-operative shoe.
This procedure offers an alternative to having the joint completely stiffened or fused (arthrodesis). The Valente Chielectomy provides some movement in the joint. Patient satisfaction varies from 72% to 100% according to studies.
It will take about 3 months before you feel the real benefits of this procedure. To ensure success it is important that you exercise the joint early in your recovery. The surgeon will discuss this in more detail with you.
It is important to understand that you will not regain full normal motion back in the joint.
- Swelling (for up to 6-9 months)
- Infection (smoking increases risk by 16X)
- Wound problems (slow to heal)
- Scar sensitivity
- Nerve Injury (Nerves can be bruised which resolves but you can be left with permanent numbness)
- CRPS = Complex Regional Pain Syndrome (Rare <1%)
- Deep Vein thrombosis (clot in deep vein in the legs)
- Continuing symptoms (if the toe still remains a problem then other surgical options may need to be considered)
Following surgery allow the foot a good 12 months to fully settle down. The surgeon will explain any particular individual risks that you may have.
The operation is usually day surgery but you may need to stay overnight if you have a medical condition or social reason that requires this. The surgeon will discuss this with you. You will be given a special shoe to wear over your bandages, which you must wear whenever you want to walk. If you had a chielectomy or interpositional arthroplasty we prefer you to return to activity as early as possible (2 weeks) and begin exercising the big toe joint. The surgeon will discuss this with you in greater detail.
You may begin increasing your activity to tolerance almost straight away, and resting/elevating the foot as required on 2 pillows. Let how your foot is feeling judge how long you remain on it. You should be able to return to normal footgear in about 2-4 weeksx