What is it?
Two operations are commonly used for arthritis of the big toe joint (hallux rigidus). A cheilectomy removes the bone spurs from the top of the joint to reduce pain and improve movement, and suits milder arthritis. A fusion joins the joint permanently with screws or a plate, and gives reliable pain relief for more advanced arthritis, at the cost of movement at that joint.
Who might it help?
- A painful, stiff big toe joint caused by arthritis
- A bony lump on top of the joint that rubs in shoes
- Symptoms that have not settled with stiff-soled shoes, insoles or injections
Is it right for you?
Treatment is tailored to your individual needs, symptoms and goals. Surgery is only recommended when it is likely to help, and non-surgical options are always discussed first.
Mr Jeyaseelan will talk you through the benefits, risks and alternatives for your situation at your consultation.
What does it involve?
- Both operations are usually day cases under a general or regional anaesthetic.
- Which operation suits you depends on how advanced the arthritis is and on your activities.
Before your operation
- You'll have a pre-assessment check, usually a week or two before surgery, including blood tests if needed
- Stop smoking, ideally at least six weeks before, as it slows bone and wound healing
- Arrange help at home for the first couple of weeks, and someone to take you home
- Prepare your home: clear walkways, and put everyday things within easy reach
- If you'll use crutches or a knee scooter, practise beforehand
On the day
- You'll be asked not to eat or drink for a few hours beforehand
- The anaesthetist will discuss the anaesthetic with you, often a general anaesthetic with a nerve block to keep the foot numb for several hours afterwards
- Mr Jeyaseelan will see you before the operation to answer any questions and mark the leg
- Before you go home, you'll be shown how to use crutches and given pain relief and written instructions
Recovery
After a cheilectomy, most people walk in a post-operative shoe for about two weeks and move the toe early. After a fusion, a post-operative shoe is usually needed for around six weeks, and the bones take around three months to fuse. After a fusion, very high heels are no longer possible.
Foot raised as much as possible, walking in a post-operative shoe.
After a cheilectomy, back in comfortable shoes and moving the toe. After a fusion, still in the post-operative shoe.
After a fusion, X-ray to check healing, then into comfortable shoes.
Return to most activities. Swelling may take longer to settle fully.
These times are typical only. You'll be given a personal recovery plan.
Getting back to normal
- Driving
- You can usually drive once you're out of a boot and can do an emergency stop safely. After right-foot surgery this is often six to eight weeks or more. Check with your insurer.
- Work
- Desk-based work is often possible after two to six weeks if you can keep the foot raised. Jobs that involve standing or walking take longer.
- Sport
- Low-impact exercise, such as cycling and swimming, usually comes first. Running and contact sport come later, once strength and movement have returned.
- Flying
- Long-haul flights are usually avoided for at least six weeks after foot and ankle surgery because of the risk of blood clots. Ask before booking travel.
Possible risks
As with any operation, there are risks. They include:
- Infection or wound problems
- Stiffness or ongoing pain
- Numbness from nerve irritation
- The arthritis progressing after a cheilectomy
- The bones not joining after a fusion
- Irritation from screws or plates
- Blood clots in the leg or lungs
Alternatives
Non-surgical options include stiff-soled or rocker-bottom shoes, insoles, pain relief and joint injections.
Conditions this may treat
Common questions
Where can I have big toe arthritis surgery in London?
Mr Lucky Jeyaseelan, a consultant orthopaedic surgeon who specialises only in the foot and ankle, sees private and insured patients with problems that may need big toe arthritis surgery at Align Orthopaedics on Harley Street, The London Clinic on Devonshire Place, HCA London Bridge Hospital, HCA UK at The Shard, HCA UK City of London on Old Broad Street and The Holly Hospital in Buckhurst Hill, Essex. See all clinic locations or request an appointment. If surgery is right for you, he will discuss which hospital suits you best.
How long is recovery after big toe arthritis surgery?
After a cheilectomy, most people walk in a post-operative shoe for about two weeks and move the toe early. After a fusion, a post-operative shoe is usually needed for around six weeks, and the bones take around three months to fuse. After a fusion, very high heels are no longer possible. Your own recovery plan will be tailored to you.
Is it covered by health insurance?
Mr Jeyaseelan is recognised by major insurers including Bupa, AXA Health, Aviva, Vitality and WPA. Cover depends on your policy, so please get an authorisation code from your insurer before your appointment.
Do I need a GP referral?
Self-funding patients can book directly, though a GP letter is helpful. Most insurers need a GP referral before they authorise your consultation, so check with yours first.
This information is general and is not a substitute for a medical consultation. Your diagnosis and treatment plan will be tailored to you.