What is it?
Movement of the big toe joint occurs typically in an up and down plane only (dorsiflexion and plantarflexion). The normal upward movement or dorsiflexion is approximately 80 degrees, and the downward movement or plantarflexion is 25 degrees. When the big toe has limited movement, we call this hallux Rigidus.
This condition is often but not always associated with some form of arthritis of the big toe. Treatment of hallux Rigidus often should be surgical but the joint can be made more comfortable with an appropriate shoe modification.
The shoes are modified by stiffening the sole, inserting a very stiff orthotic support in the shoe and sometimes adding small rocker effect (a metatarsal bar) which is glued on to the bottom of the sole of the shoe. The thinner the sole of the shoe, and the higher the heel, the worse are going to be symptoms from this condition, because more stress is placed on the big toe joint, which obviously increases pain.
The surgical treatment for hallux Rigidus is determined by the extent of the arthritis in the big toe joint. For the more minor type of hallux Rigidus, shaving off the bump on top of the metatarsal is sufficient, and this is referred to as a cheilectomy. If the movement of the big toe joint is stiff, then a cheilectomy is not sufficient and an additional bone cut may need to be performed on the big toe itself, (an osteotomy of the phalanx).
CHELECTOMY: WHAT IS THIS OPERATION?
The operation is performed for a type of arthritis of the big toe joint. Because of the arthritis, there is limited upward (dorsiflexion) movement of the big toe. The operation helps improve the pain that you get as the big toe bends up. In addition to the improvement in pain, some improvement in range of motion of the toe is also a goal, but not always possible due to arthritis. The key to a successful operation is to begin bending of the big toe as soon as possible. As soon as pain permits, you need to start bending the big toe upwards. This will ultimately improve the outcome. Because the underlying condition is from arthritis of the big toe, the outcome will depend upon the further development of this arthritis.
Before & After Pics
Specific post-operative recovery
- Foot wrapped in bulky bandage and surgical shoe.
- Do not remove surgical shoe – even at night.
- Ice, elevate, take pain medication.
- Expect numbness in foot 12-24 hours then pain.
- Blood drainage through bandage is expected, do not panic unless continuous bleeding occurs.
- Do not change bandage under any circumstances, contact my rooms before any such thoughts cross your mind.
- First follow-up in the office, X-rays taken if any incidents have occurred (falls, pain out of proportion, recurrence).
- Wound inspection with dressing Sister.
- Most of the time absorbable sutures are used and do not need to be removed and these will dissolve with time.
- Immediate and aggressive range of motion is commenced preferably in conjunction with physiotherapist.
- Massage of the scar on the top of the foot is important 3 times a day for 10 minutes at a time in order to prevent contracture of the scar which may lift the toes or cause sensitivity of the scar.
- This massage should continue for about 1 month.
- Transition into supportive sneaker.
- Wound therapy commences with micropore and Bactroban dressings for the next 4-6 weeks.
- Second followup at 6 weeks.
- Light nonimpact exercise may commence to pain and swelling.
- Expect swelling in the foot for about 6 to 9 months.
- Third followup in rooms at 12 weeks with weight-bearing control x-ray.
- Impact exercise may commence to pain and swelling.
- Continued range of motion exercises.
- Almost all activities can be resumed at this stage.
- Residual swelling and possible scar numbness expected at this point which will resolve with time (6-9 months post operatively worst-case scenario).
- Six-month followup in consultation with weight-bearing control x-ray.
- Pictures taken for comparison to preoperative state.
- Functional outcome score taken.
- Patient is usually discharged at this stage.