If you’re facing surgery for arthritis in your big toe joint, you have two main options: implant and fusion surgery. Choosing the wrong one can affect you for the rest of your life. So, in this post, we help you understand the differences between each procedure, helping guide you to a more informed decision.
Surgical Treatment for Great Toe Joint Arthritis
When arthritis in your big toe joint becomes severe enough to require surgery, you’re typically looking at two main options: joint fusion or joint replacement with an implant. Both procedures can provide excellent pain relief but they work in completely different ways and are suited for different types of patients. Understanding the difference between these procedures is crucial because the decision will affect how you walk; what activities you can go; and how your foot functions for the rest of your life.
Unlike some surgical decisions that can be revised later on, choosing between fusion and implant surgery for great toe joint arthritis is largely irreversible. The condition that typically leads to this decision is called hallux rigidus, which literally means stiff big toe. This is a stage arthritis where all the cartilage has worn away, causing bone on bone contact. The result is pain, stiffness and often bone spurs that make it difficult to bend the toe upwards. At this stage of disease development, there are two main treatment options: joint fusion or joint implant surgery.
Joint Fusion Surgery ![foot with dressing]()
Joint fusion, also called arthrodesis, involves removing all the damaged cartilage and any bone spurs from both sides of the joint. The surgeon then shapes the bone surfaces so they fit together properly, permanently fusing together the two bones of the big toe joint and securing them together with screws, plates or pins. Over the next six to eight weeks, the bones grow together to become one solid piece of bone that doesn’t move.
The biggest advantage of fusion is pain relief. Once the bones are fused together, there’s no more painful bone-on-bone contact. The joint can’t move, so it can’t hurt. Fusion also tends to be durable—once the bones are fused, the repair typically lasts for life. It makes fusion particularly attractive for younger, more active patients who want to find a long-term solution.
There are, however, some trade-offs, especially the loss of range of motion. This affects how you can walk, and it can limit certain activities. You won’t be able to wear certain high heels, and activities like yoga or ballet may be difficult because they require significant toe bending. The loss of motion also changes how forces are distributed across your foot, potentially leading to problems in adjacent joints over the next few years.
Joint Replacement with an Implant
This treatment for great toe joint arthritis takes a different approach. Instead of eliminating the joint, the surgery replaces the damaged joint surface with artificial components. Modern big toe implants are typically made of titanium or other bio-compatible metals. Some other implants are made of silicone-like polymer that simulates cartilage in the joint.
The implant procedure involves removing the damaged cartilage and reshaping the bone surfaces to accept the implant components. One part of the implant is then inserted into the metatarsal bone while the other component replaces the damaged surface of the toe bone. These components are designed to glide smoothly against each other, restoring pain-free motion.
Implant surgery’s primary advantage is preservation of motion. A successful implant allows you to maintain much of your natural toe movement, which means a more normal walking pattern and the ability to participate in activities that require toe flexibility. There also tends to be a faster initial recovery after implant surgery. While fusion requires 6-8 weeks of limited weight bearing to allow the bones to grow together, implant patients can often begin walking normally within a few weeks.
Still, implants have their own set of considerations; like any mechanical device, they can wear out over time. While modern implants are more durable than earlier versions, they may still need to be replaced down the road, especially in younger, more active patients. Implant surgery also has a slightly higher risk for complications such as infection, implant loosening and/or implant failure. If an implant fails, revision surgery is more complex than the original procedure and ultimately may require conversion to a fusion.
Choosing Your Best Surgical Treatment for Great Toe Joint Arthritis
How do you decide which procedure is right for you? Several factors play into the decision:
Age: Younger patients, particularly those under 60, often benefit more from fusion because of its durability. Since implants may need replacement over time, a younger patient may face multiple revisions over their lifetime. But older patients, particularly those over 65, may be better candidates for implants.
Activity level: High-impact athletes or people with physically demanding jobs often do better with fusion surgery because of its durability and reliability. The loss of motion is often less important than having a joint that can withstand high stress without failing. Conversely, those who enjoy activities like dancing, yoga or wearing fashionable shoes that require toe flexibility may prefer an implant.
Severity of great toe joint arthritis: Patients with severe bone loss or significant deformity may not be good candidates for implants because there isn’t enough healthy bone left to support the implant components. In these cases, fusion may be the only viable option.
Overall health status: Patients with diabetes, circulation problems or compromised immune systems may have higher risks with implant surgery. The presence of a foreign body can potentially increase infection risk in these patients. Similarly, patients with osteoporosis or poor bone quality may not be good candidates for implants because the bone may not be strong enough to securely support the implant components.
Recovery expectations: Fusion requires a longer period of restricted activity while the bones heal together. But, once healed, the repair is typically permanent. Implant recovery is often faster initially but there is also the possibility of the need for future surgery.
Need help choosing the best procedure to treat your great toe joint arthritis? Our Houston podiatrist is here to help you make the best possible decision for your future. Just contact our office and request a consultation!
