What is Total Toe Arthroplasty?
Total toe arthroplasty, also known as total toe replacement, is a surgical procedure for the treatment of toe arthritis or severe trauma to the toe in which worn out or damaged portions of the toe joint are removed and replaced with an artificial prosthesis. The most commonly performed total toe arthroplasty is the great toe arthroplasty or metatarsophalangeal (MTP) arthroplasty. The great toe is also referred to as “big toe” or “hallux.”
Arthritis is the inflammation of joints as a result of degeneration of the smooth cartilage that lines the ends of bones in a joint. This degeneration of cartilage leads to painful rubbing of the bones, swelling, and stiffness in the joints, resulting in restricted movement. Total toe arthroplasty is done to relieve pain and restore normal range of motion and function of the toe and foot.
Anatomy of the Foot
Anatomically, the foot is divided into the forefoot, midfoot, and hindfoot. The forefoot has 4 small toes called phalanges and 1 large toe called the hallux or big toe. Each of the phalanges has 3 bones and 3 joints, while the big toe has 2 bones and 2 joints. The midfoot and hindfoot have different structures, which are responsible for bearing body weight and performing activities such as walking and running.
Indications for Total Toe Arthroplasty
Your surgeon may recommend total toe arthroplasty for the treatment of following conditions, including:
- Hallux rigidus (great toe arthritis)
- Severe fracture or trauma
- Pain and stiffness of the toe
- Swollen and inflamed toe
- Damaged or worn-out cartilage
- Formation of bone spurs (bony overgrowths) on the toe joint
- Narrowing of joint space
- Rubbing of the raw bone ends
- Foot pain that is interfering with daily activities
- Failure of non-surgical approaches such as physical therapy, medications, and steroid injections to provide relief
Preparation for Total Toe Arthroplasty
Preoperative preparation for total toe arthroplasty may involve the following steps:
- A thorough examination is performed by your doctor to check for any medical issues that need to be addressed prior to surgery.
- Depending on your medical history, social history, and age, you may need to undergo tests such as bloodwork and imaging to help detect any abnormalities that could compromise the safety of the procedure.
- You will be asked if you have allergies to medications, anesthesia, or latex.
- You should inform your doctor of any medications, vitamins, or supplements you are taking.
- You may need to stop taking supplements or medications such as blood thinners or anti-inflammatories for a week or two prior to surgery.
- You should refrain from alcohol or tobacco at least a few days prior to surgery.
- You should not consume solids or liquids at least 8 hours prior to surgery.
- Arrange for someone to drive you home after surgery.
- A written consent will be obtained from you after the surgical procedure has been explained in detail.
Procedure for Total Toe Arthroplasty
Total toe arthroplasty is performed as an open surgery under regional or general anesthesia and usually involves the following steps:
- An incision is made over the affected toe joint to expose the treatment area.
- The underlying soft tissues are separated using a retractor.
- Important nerves and vessels are identified and protected.
- Joint surfaces are cleaned and damaged or arthritic bone is removed using special surgical instruments.
- This process removes the deformed part of the bone and any extra bony growths (bone spurs), as well as creates a smooth surface on which the new toe implants (prosthesis) can be attached.
- Now, artificial joint components are placed in between two sides of the damaged or arthritic toe joint.
- Once the artificial joint is properly fixed in place, your surgeon checks for range of motion and stability and closes the incision.
- The artificial toe prosthesis provides a smooth surface to the joint, allowing it to move freely, relieving pain and stiffness and improving function.
Postoperative Care and Instructions
In general, postoperative care instructions and recovery after total toe arthroplasty may involve the following steps:
- You will be transferred to the recovery area where your nurse will closely observe you for any allergic/anesthetic reactions and monitor your vital signs as you recover.
- You may notice some pain, swelling, and discomfort in the foot area. Pain and anti-inflammatory medications are provided as needed.
- You are advised to keep your foot elevated as much as possible while resting to reduce swelling and pain.
- Your foot will be secured with a dressing. Later, assistive devices such as a boot or a cast are applied for protection and to facilitate healing, along with instructions on restricted weight-bearing.
- You may need to stay in the hospital until you are able to safely walk with a cane, walker, or crutches.
- Keep the surgical site clean and dry. Instructions on surgical site care and bathing will be provided.
- Refrain from smoking as it can hinder the healing process.
- Refrain from strenuous activities for the first few months and lifting heavy weights for at least 6 months. Gradual increase in activities over a period of time is recommended.
- An individualized physical therapy protocol may be recommended to help strengthen foot muscles and optimize foot function.
- Most patients are able to resume their normal activities in a month or two after surgery; however, return to sports may take at least 6 months or longer.
- Refrain from driving until you are fully fit and receive your doctor’s consent.
- Periodic follow-up appointments will be scheduled to monitor your progress.
Risks and Complications
Total toe arthroplasty surgery is a relatively safe procedure; however, as with any surgery, some risks and complications may occur, such as the following:
- Damage to surrounding tissue
- Bone or joint irritation
- Bone loss
- Pain and discomfort
- Joint stiffness
- Swelling and inflammation
- Scarring and delayed healing
- Thromboembolism or blood clots
- Revision surgery