• Book Appointment
  • Phone: 1300 522 096
  • Fax: 07 5676 9695
  • Email: info@footsurgery.com.au

Hallux Limitus/Rigidus (Cartiva)

This may develop due to big toe joint overuse in workers who squat & stoop, or athletes who put too much pressure on the joints.

Hallux Limitus/Rigidus

What is Hallux Limitus/Rigidus?

Hallux limitus refers to a condition where your big toe joint (first MTP joint) loses its range of motion. This condition can be troubling and painful as we use our big toe joint whenever we walk, stoop down, climb up or even stand. Since hallux limitus is a progressive condition, the toe’s motion decreases as time goes on and reaches the end stage of condition known as hallux rigidus where you completely lose range of motion at the big toe joint.

When Hallux Rigidus advances to a point where your big toe cartilage erodes, everything you do with your feet becomes increasingly tricky and painful. You cannot engage in walking, sports, and even household or social activities.

Hallux Rigidus (also known as big toe joint arthritis) is caused by an acute traumatic or repetitive microtrauma event, which in turn leads to an arthritic process around the big toe joint. It causes pain and stiffness in the joint where your foot joins the big toe known as the first metatarsophalangeal joint.

Your big toes hold up to 50 – 60% of your body weight when you are walking, or up to 100% of your body weight when doing vigorous exercise. This pressure is what causes your joint to wear down, leading to painful big toe arthritis – Hallux Rigidus.

Causes

Faulty biomechanics and structural abnormalities: Abnormal pronation may put excessive pressure on the big toe that then needs to work harder to push off and move the body forward, then joint cartilage becomes overly compressed and damaged.

Previous injury to the big toe joint: Stubbing the big toe or dropping a heavy object on the big toe joint.

Frequent wearing of high heel shoes or tight shoes: 

Overuse: In activities or jobs that increase the stress on the big toe joint such as workers who have to stoop or squat.

Inflammatory arthritis: Rheumatoid or gouty arthritis or Osteoarthritis.

Treatment

Conservative

Self-care at home: aim to reduce the inflammation, swelling and pain in the big toe and the joint.

Rest: rest the foot by putting weight off the joint.

Shoes: wear shoes with a rigid sole (to reduce the big toe joint from bending), a wide and deep toe box, and no raised heel (to reduce compression of the cartilage in the big toe joint).

Soaking the foot: warm water can help soothe the inflamed and painful joint.

Gentle massage: massage with topical anti-inflammatory gel.

Professional treatments:

Medication: Anti-inflammatory and/or pain medication.

Orthotics: to compensate for abnormal pronation or sometimes limit the motion at the big toe joint.

Injections: Ultrasound guided steroid injection.

Surgical

Depending on the stage of your hallux limitus/rigidus and your symptoms the type of surgery performed varies.

Cheilectomy: Usually recommended for mild to moderate deformity and aims to increase range of motion by removing bone spurs and portion of bone to allow more room for the toe to bend and alleviate pain.

Arthrodesis: It is recommended for moderate to severe hallux limitus/rigidus where joint damage is severe. In this procedure the damaged cartilage is removed from both sides of the joint and two bones are fused together with screws and/or a plate. It mainly aims to eliminate the arthritis and pain.

Cartiva: A revolutionary treatment for people suffering from big toe arthritis pain is Cartiva Surgery. It’s one of the most advanced treatments for the late-stage big toe arthritis.

A synthetic cartilage implant designed to replace your damaged cartilage. The new implant consists of durable, bio-compatible, and slippery organic polymer that has the same functionalities to natural cartilage. Cartiva implant surgery does not carry the risk of bacterial or viral infection. It is designed to withstand loading and reduce any chances of systematic irritation. After Cartiva Surgery there is less bone healing required. This is opposed to fusion surgery, Cartiva Surgery does not have a long recovery time. Before Cartiva Surgery, the other options for the surgeons and patients were to fuse the joint that leads to complete loss of motion at the big toe joint. Although the procedure was still effective in relieving the pain, patients lost the mobility of the big toe making walking and wearing certain shoes a little tricky – and their active lifestyle too.

Hallux Rigidus (stage 4) - 1st MPJ Arthrodesis
Hallux Rigidus (stage 4) x-ray - 1st MPJ Arthrodesis
Hallux Rigidus (stage 3) + 2nd toe dislocation - 1st MPJ Arthrodesis + Modified Weil Osteotomy
Hallux Extensus (patient called it Banana Toe) - Keyhole Tendon Lengthening + Skin Plasty under local anasthesia

Appointment Information

Cost & Item Codes – Our fees are quoted on a case-by-case basis after your initial consultation with the surgeon as each patient presents differently and each surgery varies from patient to patient. Please book an initial consultation to discuss this further.

Scans – We recommend you have weight bearing x-rays prior to your appointment.

Telehealth – We may be able to offer an initial telehealth appointment if you live a distance away. Phone one of our friendly staff to see if this is possible for you. We may ask you to email some photos prior to your appointment. (1. from patient looking down at the front of their foot/feet 2. if someone can take a photo at floor level from behind of foot/feet)

Surgery Information

Do I need surgery? – Although your surgeon may recommend an operation to improve the function of your foot, reduce pain, and restore your range of movement, it is your decision if you go ahead with the operation or not.

When you consult a foot surgeon, they will take into consideration the deformity on your feet, your age, and the level of your activity before deciding on surgery.

As with many arthritic conditions it is progressive, and stiffness will increase.

Duration – Surgery can typically take between 45 minutes to 1 hour to complete, and patients can usually return home the same day.

Anaesthesia – Surgery can be performed under general anaesthesia, local anaesthesia, or regional anaesthesia, depending on the surgeon’s and the patient’s preferences.

Medications – Your surgeon will discuss all medications with you on your initial consultation.

Smoking – If you are a smoker, you need to stop the habit of smoking 4 weeks before your operation for normal healing and reduce postoperative complications. Nicotine is known to stop bones from healing.

Recovery Process

The following should be adhered to in order to hasten your recovery from foot surgery.

In general, the following timeline can be expected:

Immediately after surgery: Go home and rest. Elevate your foot as often and as much as possible to reduce swelling. Take pain medication as instructed and avoid smoking. Wear post-operative shoe all the time, even at bed for the first 2 weeks. Place a plastic bag over your foot when showering.

Some blood ooze can be expected in the bandage, but if worried, contact the number given.

The first few days: Patients will need to spend most of the time with the operated foot raised to reduce swelling as much as possible.  You should restrict your walking in the postop shoe to minimal activities such as going to the bathroom only.

1-2 weeks: In the first 2 weeks, keep the foot dry until stitches are removed.

Movement is limited out of the house and patients are expected to rest and elevate as much as possible in a post-op shoe even when they are advised they are able to walk.

Walking – Cheilectomy: 0-4 weeks Full weight bearing in a post-op surgical shoe. >4 weeks Full weight bearing in a normal comfortable shoe.

Walking – Arthrodesis: 0-6 weeks Full weight bearing in a post-op surgical shoe. >6 weeks Full weight bearing in a normal comfortable shoe.

Walking – Cartiva: 0-4 weeks Full weight bearing in a post-op surgical shoe. >4 weeks Full weight bearing in a normal comfortable shoe.

Driving – Your surgeon will advise when you can start driving, usually 4-8 weeks after surgery.

Cheilectomy: 4-6 weeks

Arthrodesis:  6-8 weeks

Cartiva:          6-8 weeks

Return to Work sedentary – If you work at a desk with minimal time on your feet and you are able to elevate your foot/feet, you may be able to return to work between 2-4 weeks.

Return to Work active – If you have a physical job or are standing a lot and unable to elevate your foot/feet, you may not be able to return to work until 6-8 weeks.

Low impact exercise8 weeks as instructed and as tolerated. eg slow walking, cycling, golf using caddie.

High impact exercise12 weeks as instructed and as tolerated. eg fast walking, running, jumping, playing sport.

Some possible complications following surgery include – pain, infection, bleeding, scarring, DVT. Patients should contact their surgeon if they experience any signs of complications, such as fever, redness, or increased pain in the affected foot.

Cheilectomy: Arthritis progression, Nerve damage.

Arthrodesis:  Delayed union or non-union, Nerve damage.

Cartiva: Joint stiffness, Impant subsidence, Foreign body reaction to the implant.

Surgery

Surgery is advised if non-surgical treatment fails.

Do I need Cartiva Surgery?

If pain and stiffness persist and standard treatment such as footwear, injections and orthotics do not improve your symptoms, you may need to consider big toe surgery. The surgery will be the only way to eliminate the pain.

When you consult a foot surgeon, they will take into consideration the deformity on your feet, your age, and the level of your activity before deciding on surgery, administering the Cartiva procedure to your big toe.

Am I a candidate for Cartiva Surgery?

Unfortunately not everyone with arthritis in the big toe joint (1st MPJ) is a candidate for Cartiva surgery. During your consultation, Dr Kim will assess your big toe joint and discuss what treatment options are available. If you are not a candidate for Cartiva surgery, Dr Kim will still offer alternative treatment option.

What is Cartiva Surgery?

Cartiva surgery is a synthetic cartilage implant. It’s designed to replace your damaged cartilage. The new implant consists of durable, biocompatible and slippery organic polymer that has the same functionalities to natural cartilage.

Cartiva implant is designed to withstand loading and reduce any chances of systematic irritation.

The surgery is quick and safe. Cartiva procedure takes approximately 60 minutes. Dr Kim (Specialist Podiatric Surgeon in Brisbane and the Gold Coast) will replace your damaged cartilage with a new Cartiva synthetic cartilage implant.

Cartiva Surgery has had great success in America since July 2016. The procedure has recorded a 97% success rate.

In the level 1 study, the Cartiva synthetic cartilage implant increases big toe motion by 175% while reducing the pain by 97%. After a Cartiva implant procedure, you will be back to walking and enjoying a pain-free lifestyle – you will feel young again.

How Long Will the Cartiva Synthetic Cartilage Implant Last?

A lifetime. You can also remove or replace the Cartiva implant whenever you wish without any complication.

Cartiva is designed to last a lifetime and there have not been cases in the literature reported that patients require replacement of Cartiva yet.

Get Your Life Back Today

If your big toe is holding back your life, it’s time to seek treatment.

Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.

Podiatric Surgeon Dr Kim is the leading surgeon for Ankle and Foot Surgery in Brisbane and Gold Coast, contact him today to see if you are a good candidate for Cartiva surgery.

No referral needed

Contact Us

A GP referral is welcome however it is not essential for your appointment

About

Dr Ji Soo Kim (Specialist Podiatric Surgeon) BPodM, DClinPod, FFPM RCPS(Glasg)

Book Appointment

Dr Kim has two offices, one located in Kelvin Grove, Brisbane. The other is in Southport, Gold Coast.

Please call 1300 522 096

    • Ingrown Toenails

      Ingrown Toenails

      Don’t wait for that ingrown toenail to become infected and painful.
      Don’t suffer any longer from recurring or chronic ingrown toenails, there is a cure!

    • Minimally Invasive Surgery (MIS) Keyhole

      Minimally Invasive Surgery (MIS) Keyhole

      MIS foot surgery doesn’t involve a long incision. It results in less trauma to muscles & soft tissue surrounding the foot & in most cases less pain & faster recovery.

    • Bunion

      Bunion

      Do you have a bony, painful bump at the base of your big toe? Bunions can form at this joint and will not go away on their own. This doesn’t mean that your lifestyle has to be affected, we can help.