Great Toe Arthritis (1st MTPJ OA)
Presentation
Patients will have pain and stiffness of their big toe joint. There are often prominent bony lumps on the top of their foot (dorsal osteophytes).
Investigation
Your GP should initially request these investigations:Weight bearing foot X-ray (AP and lateral)
Your surgeon may also request the following investigations for more information or surgical planning:
MRI to look at chondral damage
Conservative Treatment
Initial treatment of Great Toe Arthritis (1st MTPJ OA) could include:Orthotics with a rigid sole or Morton’s plate may provide symptomatic relief. Injections of corticosteroid and local anaesthetic may improve pain for a variable length of time.
Surgical Treatment
Surgical treatment of Great Toe Arthritis (1st MTPJ OA) includes:Cheilectomy - removal of the dorsal osteophyte and dorsal part of the joint.
- only suitable if joint cartilage in good condition
- preserves movement at MTPJ
MTPJ arthrodesis (fusion) - stiffening of the joint
- Incision along inner border of big toe
- Joint surfaces removed and bony edges held together with screws and plate
- Wound closed with non-absorbable stitches
- Foot bandaged and placed in Darco MedSurg flat shoe
Condition specific risks include:
- Non-union
- Metalwork failure
- Metatarsalgia (pain under forefoot)
General risks of surgery include:
- Infection
- Damage to nerves/blood vessels
- DVT / PE (blood clots)
- Anaesthetic risks
Recovery
Recovery from Great Toe Arthritis (1st MTPJ OA) surgery will include:- Keep foot elevated as much as possible, especially for initial 72 hours
- Keep dressings dry and intact until post operative appointment.
- Pain killers may be required for up to 2 weeks.
- Removal of stitches: 10-14 days at first post operative appointment.
- Protected weight bearing for 6 weeks:
- post operative flat DARCO shoe.
- crutches as required.
- Maximum comfortable heel height 3 cm.
-
Recommencement of most activities: 12 weeks. Full recovery: 3-6 months.
Every patient’s recovery is individual and depends on the severity of the injury and the complexity of the surgery.