If symptoms persist or recur despite conservative therapy, surgical therapy should be considered. Because osteoarthritis is a progressive (advancing) disease, joint-preserving surgery is usually associated with only temporary success.
The following surgical therapies may be used, depending on the symptoms or degree of joint damage:
- Arthrodesis (stiffening) of the metacarpophalangeal joint.
- Indications:
- Severe form of hallux rigidus
- Young, active people
- The base joint of the big toe is already destroyed
- Indications:
- Cheilotomy – joint-preserving; bone attachments to the metatarsal and proximal phalanx of the great toe are removed, including the inflamed synovium (synovium or synovial membrane) if necessary; facilitating extension of the proximal joint of the great toe.
- Indications:
- Mild form of hallux rigidus
- The joint is still undamaged
- Indications:
- Endoprosthesis (joint replacement)
- Total endoprosthesis: both joint partners are replaced
- Hemiprosthesis: only one joint partner is replaced
- Note: Long-term studies showing reliable success are still missing!
- Osteotomy (cutting of bone) – shortening of the metatarsal bone to relieve pressure on the metatarsophalangeal joint of the big toe and to prevent progression of the disease.
- Resection arthroplasty (change in shape by removal of the joint and formation of a false joint (pseudarthrosis)) according to Keller-Brandes – not joint-preserving; is now performed only in rare cases; a residual mobility is preserved, but the function of the big toe is disturbed when walking
- Indications:
- Older, less active individuals
- Advanced osteoarthritis in the metatarsophalangeal joint of the big toe
- Indications:
Aftercare
Depending on the surgical procedure performed, immobilization of the foot is required for a defined period of time, for example in a therapeutic foam shoe, forefoot relief shoe or in a plaster cast. Physical therapies should then be started early.
