Big Toe Joint, Hammer Toe & Bunionette Problems:
Big Toe Fusion Operation [PROs vs CONs & Best Recovery Time]
A Big Toe Fusion Operation has many PROs and CONs: Generally it is a very reliable but more permanent, fused procedure than other bunion procedures.
- The associated photos are pictures of bunions.
- There are multiple stages of bunions ranging from minimal dislocation, to severe dislocation, to severe dislocation with arthritis.
- It is important to note that the sesamoid bones dislocate from the big toe joint, and that it bunion itself is more of a dislocation injury than a arthritic injury.
- Although we frequently see bunions that also have arthritis, and is much more likely.
Please click on the gallery to read description! Feel free to share pictures.
Big Toe Fusion Overview:
- This page will focus on the surgical technique of performing the big toe fusion operation from skin incision, proper technique through to recovery time.
Big Toe Fusion Skin Incision:
- Dorsomedial incison at the 1st MTPJ- just medial and parallel to the extensor hallucis longus tendon.
- Extend incision just proximal and distal to the 1st MPJ joint and release the periarticular soft tissues from the joint margins.
- If this is for Hallux Abducto Valgus- do not bother with a lateral capsule release as this will correct itself when shortening and fusing the 1st MPJ
- Use a T-shape for the joint capsule and extend the vertical arm plantarly.
- The sesamoids are not generally arthrodesed to the 1st ray, but if painful they can be(quantify if severe pain ahead of time).
- If there is a significant callus under the sesamoids, if there is a hypertrophied sesamoid or if they are fractured, they are then routinely excised.
Big Toe Joint Fusion Surgical Technique
- All cartilage must be resected from the 1st MPJ until bleeding bone is present, if the bone is extremely arthritic (subchondral sclerosis), then it is necessary to fenestrate the bone further to encourage healing.
- The joint can be cut in a cup-in-hole (only really practical for screw fixation- not plate or staples) configuration or left flat (need flat if using staples or plate fixation). Can use an interpositional bone graft to maintain the joint space.
- Reciprocal planing-hold the joint in the desired final position- then use the saw blade to section the joint until it fits together properly. The problem with this is excessive shortening and if a graft is not possible – then the ball in cup fusion may work much better.
- A ball in cup arthrodesis is made possible through the use of reamers to shave down the cartilage surface. It is also possible to change the positioning of the ball in cup 1st MPJ before it is fused without extra cutting. Be careful because a change in position can occur with ball in cup rather than planar positioning!
- Typically the sesamoids are left intact to aid with the fusion, but if calluses, hypertrophy, fracture or severe pain they can be resected.
First Metatarsophalangeal Joint Position:
- -Sliding the joint both dorsally and laterally is possible to limit plantar pain and hallux interphalangeus abductus, but the majority of the position should be accomplished by angling not through sliding.
- -There is no exact position- but generally dorsiflex slightly and abduct slightly but not to the point of touching the 2nd toe. Temporarily fixate the position with 2 crossing K-wires (these can be done percutaneously) before permanently fixating to check for patient satisfaction.
- -Confirm position and screws with the C-arm. Mimic weight-bearing with a flat board to see what happens.
- -The exact angular position is not the most important thing, but how it looks on mimicked weight bearing.
First Metatarsophalangeal Joint Fixation:
- -Any technique can but used, but usually the most often employed and proven technique is percutaneous pins. They can be inserted 2 at an angle to prevent rotation, they can then be easily pulled out. The buried K-wire technique can be utilized to prevent unsightly pin protrusion from the digit for the patient.
- -Plates are used usually only when a bone graft is employed for length, lower profile plates are utilized to prevent irritation in the shoe gear. A second procedure will usually be used to remove the plate at a later point.
- -Screws are difficult to use due to the lack of bone stock in the 1st MPJ. They greatly reduce the bone surface for arthrodesis.
- -External fixators are used to prevent deforming forces, but are usually employed for the compression of sharp bone segments.
- -Staples are good for planar surface apposition of the 1st MPJ.
- Follow this link to see what helps with recovery time and how long it will take to get better.
- Big toe joint pain replacement recovery time can be less that a few weeks until you are back into your shoes.
- Suture recovery generally is not needed due to dissolving stitches.
- You can then progress into a surgical shoe within the first 2-3 weeks.
- As long as this is a very supportive shoe.
- You will feel about 50% at 6 weeks.
Best Bunion Relief Infographic:
Big Toe Joint Injury or Surgery Treatment:
- If you think you might have severe turf toe, a severe tear or sprain, a broken big toe joint or broken big toe, or you have just had surgery: this guide may be able to help you!
- Just make sure to check with your podiatrist because a severe injury will require imaging, bio-mechanical evaluation and a good discussion to prevent anything from going more wrong.
- For surgery purposes make sure to discuss with your podiatrist To see what is recommended, as every surgery is unique and there are pros and cons to all treatment methods.
Big Toe Joint Fracture, Sprain or Surgery Products:
- If you have a traumatic injury such as a broken bone or ligament tear, these products may be able to help you.
- The best way to do this is of course to see your podiatrist and get evaluated with an x-ray, ultrasound and potentially even an MRI or CT scan.
- If you are unable to do so it may benefit you to be in a cast, fractured boot, or even keep the weight off of it with a rolling knee scooter or other protective devices.
- We as podiatrists frequently take patients off work for very long period of time when they suffer a traumatic injury, unfortunately there is no other way around us in labor jobs.
- If you have a sit down job there are ways to get people back to work quicker, but this can be very difficult otherwise.
- Just remember these injuries can take a very long time specifically 2 to 3 months or more to come back from if you’re going to be on your feet all day. There is a long recovery time and healing time in most cases.
Big Toe Joint Injury & Surgery Immobilization:
- There are pros and cons to using a boot to treat your big toe joint injury. If you are immobilized too long the cons are that you will gradually become stiff and overworked to your other leg. The Pros are that you injured heel will hopefully have a chance to gradually heal!
- Our favorite fracture boots and their supplies:
Big Toe Arthritis and Hallux Rigidus:
- One of the best treatment options for a stiff big toe is a stiff orthotic.
- The big toe can become arthritic, and what causes the pain is the bone grinding on a joint that cannot move.
- Getting a rigid carbon insole, can make a very big difference in preventing the bend of the big toe joint.
- Out of the big toe joint products in the next table, the carbon insole is one worth looking at for relieving big toe joint bed.
- A good over-the-counter orthotic can provide a similar result, and we would otherwise prefer those.
Offloading and Scooter Treatment:
- If you cannot use your foot, and it further needs to be immobilized: we have found success with offloading the scooters in these products.
- Crutches can be difficult long term, whereas scooters can really help you get around and to work if you have a sit down job in this been okay-ed with your podiatrist.
- These are our favorite knee scooters and walking devices:
Best Big Toe Joint Products:
- There are usually two phases to treating big toe joint pain
- The two phases of treatment include controlling the acute inflammation with protection, and correcting the bio-mechanics which led to the problem in the first place.
- If the tendons, joint and ligaments are inflamed, they are almost frozen in place and cannot function properly.
- Inflammation can mean damage as well, in this most likely needs to be protected as the big toe joint is a heavily relied upon weight-bearing joint. So consider discussing with your podiatrist the need for and offloading surgical shoe or boot.
- Once the inflammation is decreased, we need to correct the bio-mechanical causes to ensure that they can never become over worked and inflamed again!
- The key with an injury or surgery is to keep it protected initially, and when the bone and tendon heels, to get moving before stiffness can set in.
Best Bunion Specific Products:
- There are no perfect bunion treatment products.
- Most people end up disappointed after spending a lot of money on bunion pads, bunion gel pads, expensive bunion correctors and bunion splints!
- The truth is a bunion is a biomechanical injury, it is because the foot is flattening out and ankle is flattening out causing the pain.
- Having a gel pad on the big toe has very little chance of fixing the deformity, although it can stop the rubbing and relieve a lot of the pain.
- This is why people sometimes where the splints and correctors, it holds the toe straighter so that the tissue and were’s and have left pain.
Big Toe Joint Inflammation Control:
Massage & Ice Products:
- Ice is the an excellent option that can be safe for almost everyone.
- There is some debate whether icing is worth doing, but for chronic pain this can help limit the need for medications and keep your options open.
- This works great for your arch, less for the ball of the foot.
- The more muscle and ligament tissue there is, the better ice will work there.
Menthol Based Gels:
- Biofreeze is one of our favorites.
- This can work well as a cream or gel option for your big toe joint pain.
- These gels have been studied to work 2x as long as ice.
- This works great for the ball of the foot.
- This can be very effective for bottom of the heel and Achilles tendon sore regions.
- These can work great for loosening your muscles.
- This is not to be uses directly onto you foot, but to help take pressure off of the front of the foot.
- This allows less tightness and pressure on the ball of your foot.
- This is very effective for the arch, the gastrocnemius or calf muscle and for the hamstring and thigh muscles.
- This also works very well for the gluteus muscles if you are having butt cheek or hip pain.
Remove the Big Toe Joint Pressure:
- The key is to prevent future pain and to keep pressure off of the big toe joint.
- This means keeping you active while keeping stress off of your big toe joint. This will prevent future bunions, sesamoiditis, turf toe and even big toe joint arthritis!
- If you can get rid of the pain and swelling, this will let you start walking normally.
- If you can walk normally, the vast majority of your pain should gradually start to go away.
- The best way to ensure that your big toe joint, hammertoes and foot and ankle ligaments are not overworked is to support them.
- The best way to support them is to use great orthotics and great shoes.
- Some people may also need to rely on supportive ankle braces and other supportive modalities.
Best Big Toe Joint & Flat Foot Shoes:
- Getting a great supportive pair of shoes will make sure that there is no further pressure onto the ball of your foot and the big toe joint region.
- This is especially important if you have plantar fasciitis, heel spur pain or Achilles tendonitis.
- Consider shoes combined with a good supportive orthotic for best pain relief!
- We have found shoes and orthotics to be one of the most effective ways to reduce bunion and hammer toe pain.
- The following link will show you what our favorites are.
Best Big Toe Joint & Flat Foot Orthotics:
- These are our recommended orthotics for offloading the big toe joint.
- Custom orthotics can work very well, but they should not be a first line of treatment. Custom orthotics can cost a lot of money, over the counter orthotics can be a great introduction to foot control and to prevent pronation.
- There are different types of orthotics for different types of shoes.
- Women’s shoes usually need a less bulky orthotic, but allow for less correction of your big toe joint and ball of the foot pain.
- A full length orthotic requires a running shoe, boot or comfortable walking/dress shoe.
- We recommend doing everything you can to get a good supportive shoe that can fit a full length orthotic. This will get you the best results for your bunion, hammer toes and bunionette.
- This is the best way to maximize your orthotics for great results.
Best Full Length Orthotics:
- These will only work in wider shoes or a good supportive running shoe.
- This will not work in sandals, flats or most women’s dress shoes.
Best Dress Shoe Orthotics:
- These are a great choice for dress orthotics.
Best 3/4 Length Orthotics:
- These are great options for women’s dress shoes and thinner shoes.
- These are not the most supportive pair of orthotics.
Get A Great Dynamic Stretch:
- The goal of getting a great stretch is to improve your ankle flexibility and prevent ball of the foot pain and big toe joint pressure.
- It is possible to stretch on your own, but these products can also really help!
- This will take pressure off of the ball of your foot.
- We personally prefer this method of stretching.
Get A Great Static Stretch:
- These devices are great for stretching while you are resting.
- This will also help take pressure off of the ball of your foot.
- This works great for plantar fasciitis, but can also make your ankle more flexible to remove pressure from the ball of your foot!
- It can be used while watching TV or at night time.
Big Toe Joint, Hammer Toe & Bunionette Problems: