Big Toe Joint, Hammer Toe & Bunionette Problems:
Pros and Cons of Big Toe Joint Fusion [The Best Big Toe Joint Surgery?]
Pros and Cons of Big Toe Joint Fusion: It is a bigger and more final procedure, but it is usually the only bunion surgery that you will EVER need!
- Big toe joint pain can be improved with a few simple treatment changes.
- We are foot doctors & we see this problem get better almost every day.
- The goal is to solve this problem without medication or surgery if possible.
So, let’s GO!
- A bunion is a pre-dislocation of the big toe joint.
- Big toe joint arthritis is also known as hallux rigidus and can form a very large big toe joint spur.
- A turf toe is the hyperextension and bending of the big toe joint. This can cause ligament and tendon damage.
- Sesamoiditis of the big toe joint is the inflammation and possible fracture of the two bones underneath your big toe joint.
- Gout in the big toe joint is the buildup of the crystal substance called the uric acid.
So, check out the big toe diseases by clicking on the photo gallery for descriptions!
So, check out the big toe diseases by clicking on the photo gallery for descriptions!
Pros and Cons of Big Toe Joint Fusion Overview:
- This is the most predictable procedure available to the foot and ankle surgery.
- This is reliable and essential ensures you will only need one surgery if your life if all goes well. The down side is that it is very permanent and you will no longer have motion in the joint.
Pros and Cons of Big Toe Joint Fusion:
The big toe joint fusion is recognized as being the “most permanent and satisfactory correction of hallux valgus(bunion)”. Numerous studies over the years have indicated that this is the most predictable and effective surgery for any type of bit toe joint deformity or arthritis.
Pros of Big Toe Joint Fusion:
- Better long term results and happiness.
- More stable.
- Better pushoff strength.
- It will not shorten over time like a arthroplasty might(more chronic arthritis will develop).
- Long term durability.
Cons of Big Toe Joint Fusion:
- Longer recovery time.
- No joint motion means less shoe options.
- Shorter bone may mean less contact to the floor(more pressure on the 2nd metatarsophalangeal joint).
- No going back unless you get more surgery.
Frequently asked questions:
Primarily used for Hallux Abducto Valgus and Hallux Limitus:
- The big toe fusion is called a McKeever bunionectomy.
- It is primarily used for both severe hallux abducto valgus deformities(bunions) and stiff big toe joints due to osteoarthritis
- Big toe joint arthritis is termed hallux limitus and hallux rigidus.
Secondarily used for Repair of Failed Surgeries
- The big toe fusion is secondarily used to repair severe/recurrent surgeries.
- This is a favorite procedure of ours!
Reconstruction can be used for these conditions:
- Hallux abducto valgus.
- Failed implant joint arthroplasty (remodelling)
- Hallux varus.
- Primary first MPJ osteoarthritis.
- Post traumatic arthritis.
- Inflammatory and septic arthritis and various other neuromuscular conditions.
People are Usually Very Happy with the Operation
- An appropriately fused big toe joint has shown to have the greatest long term patient happiness.
- This happiness regarding no further recurrence, a pain standpoint and a functionality standpoint.
- It seems that the only problem is the psychology behind telling a patient that their joint will be fused and they expect that it is much worse than it really is.
Should I Remodel the Joint or Fuse the Big Toe?
- The big toe joint fusion has the benefit of locking the toe in proper position as well as removing pain in the joint.
- The big toe joint arthroplasty (remodelling) procedure is beneficial in the case where the position is not a big problem such as in a straight joint with a mild amount of joint damage.
- The arthroplasty is also beneficial because it allows for more types of shoes to be worn.
- The benefits of the big toe joint fusion (arthrodesis) is that you will have a greater degree of push-off strength in the joint.
- It essentially guaranteed prevention of future pain and improper positioning if all goes well with the surgery.
- The arthroplasty has a quicker healing time but weaker push-off strength (less of a problem if the patient is already apropulsive).
- More stable, Better pushoff strength, Better long term results and happiness, will not shorten over time like a arthroplasty might(more chronic arthritis will develop).
- Longer recovery time, No joint motion means less shoe options, shorter bone may mean less contact to the floor(more pressure on the 2nd metatarsophalangeal joint).
Who should Avoid Big Toe Fusion
- People who need to kneel and bend should choose remodeling over fusion. Bowlers and carpet layers need to bend their big toe joint every day, people like this should avoid it.
- People who cannot tolerate being immobilized in a boot for any extended period of time(cast or CAM Walker).
- Anyone who plans to wear heels larger than 1″ tall. This will basically cause you to develop hallux rigidus as the big to will press against the floor in its fused position, causing a callus to form on the inside of the big toe.
- A detailed guide on the principles of the surgery and how it is performed by the podiatrist.
- A rough estimate on how long it will take for your joint to fuse and what you can do to speed that up.
Big Toe Fusion Complications:
- Nonunion and mal-position are the two major complications.
- Nonunion- this can be prevented by proper fenestration and ensuring that the patient does not have any systemic problems such as smoking or diabetes.
- If this does occur the painful non-union will need to be excised and then filled in with a bone graft.
Bone Spur on Top of the Foot Surgery Recovery Time Protocol:
This guide will detail the length of specific step by step bone spur surgery recovery time.
Day 1: Top of the Foot Spur Removal Surgery Day:
- The actually surgery takes well under an hour, and your foot is usually numbed up for the rest of the day.
- Some people don’t need much if any pain medication outside of anti-inflammatories. If you do have pain to this site, then it is normal to have a prescription for a narcotic pain medication for the days immediately after the surgery.
- After surgery you will wake up with a dressing on your foot. Keep this dressing in place and your pain will be well under control with medication.
- No implants or bone healing is necessary, except for the healing of bone pain.
- You can wear a boot over your dressing almost immediately.
- Most physically able people do not need crutches or a walker unless they have other health issues.
- Usually there are about 2 sutures in the foot.
Day 7: Top of the Foot Bone Spur Removal Surgery Postoperative Visit #1:
- Within about a week, we have the first postoperative visit.
- You will have an X-ray at this visit and we will make sure there is no irritation or damage to your dressing.
- With this dressing change some antibiotic ointment is applied, we make sure you are not having any problems at this time.
- Sutures are not removed yet at this visit.
Week 2-3: Top of the Foot Bone Spur Removal Surgery Postoperative Visit #2:
- This can fluctuate depending your overall health needs, physical fitness and life needs.
- If you are able to rest more, weight less and are really healthy, sutures can usually come out at 2 weeks. Some patients need to walk and be more active, if this is the case you will likely need sutures longer and have a larger dressing.
- If you swell more and are more tender, they can stay in a little bit longer.
- If you are a smoker or have decreased healing ability, we may need to keep your sutures in place longer.
- At this point your incision site should be healed.
- At this point you will wear a band-aid for 2 weeks and walk in a good supportive running shoe.
Week 5: Postoperative Visit #3:
- This is what the incision site will look like after the sutures are removed at 2-3 weeks or so.
- If everything looks good, you no longer need to wear a band-aid.
- At this point you will still be sore but can transition back into more normal function.
2 Months: Postoperative Visit #4:
- At this point you continue wearing a good supportive orthotic and good shoe.
- If everything is feeling well you should be close to healed.
- Keep in mind that you will continue improving for about 6 months total. But at this point you should be feeling better than you did prior to when you have a heel spur.
Treatment algorithm for bunion surgery:
- Find out if a different procedure is best for you.
- A metatarsal joint fusion may not always be worth it.
- Many times other procedures are just as effective and the healing time can be much quicker.
Resources for Big Toe Joint Fusion:
Big Toe Joint Home Treatment:
- If you have read the above causes and symptoms, and you are confident that that what you have is big toe joint arthritis, then the below might be a good idea to look through.
- If you are considering big toe joint fusion, these options may be something to consider before surgery.
- This is not something that we would recommend doing at home, but a doctor can help you with this.
- If you do have severe pain that is really preventing you from doing anything, this may be an option in the right circumstances.
- Anti-inflammatory medications could be good, but we do not recommend this as a long-term solution.
- Focus on the orthotics in the shoes.
When is surgery a good option? Probably only 10% of the time!
- If you have tried all the above stuff, and a couple months have gone by and you have not started to improve at all, then further and imaging like an ultrasound, x-ray or MRI might make sense.
- If you have long-term permanent damage to the big toe, especially if it has been going on for over 6 to 12 months, then you may need surgery.
- Bunion surgery has its benefits, but any type of surgery may have its negatives.
- Make sure to check with a podiatrist to see if you qualify. You may be one of the 10% for whom it may be a great idea!
Big Toe Joint Home Treatment 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: