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Introduction: Great toe replacement, or metatarsophalangeal (MTP) arthroplasty, is a surgery that is performed to remove the damaged portions of the great toe joint (MTP joint) and replace them with artificial components. 

Function: To relieve pain as well as to restore and maintain the function of the great toe and foot and to help improve range of motion. 

History of Injury: Although some people may need great toe replacement after an injury, more often the procedure is performed on people who are dealing with the effects of rheumatoid arthritis or osteoarthritis, such as hallux rigidus, which is the growth of bone spurs on the great toe joint due to bones rubbing together.

Diagnosis: Your orthopedic surgeon will ask you questions about your general health as well as your toe and foot pain and how it is impacting your ability to function. He or she will also perform a physical exam to assess the strength, range of motion, and condition of your great toe. To better understand the damage, your surgeon will have X-rays taken of your foot. 

Treatment: Great toe replacement if your condition is severe, or a nonsurgical option if your orthopedic surgeon recommends it.

Initial: Before recommending great toe replacement, your orthopedic surgeon may suggest other treatments, such as steroid injections, medications, metal bracing, or wearing footwear with large toe boxes, in addition to avoiding activities that could make your symptoms worse.

Long Term: If nonsurgical treatments are not helpful or no longer relieve your pain, great toe replacement could be a good option for you.

Indications for Surgery: If you are older or have limited demands on your feet and are suffering from rheumatoid arthritis, osteoarthritis, or hallux rigidus and your foot pain is interfering with your daily life—even while you are resting—you may be a good candidate for great toe replacement. 

Surgery: Great toe replacement takes place in a hospital, and you will be given general anesthesia. Your orthopedic surgeon will make an incision on the top of your great toe, and he or she will remove the damaged portions of your MTP joint. Using special instruments, your surgeon will then prepare the bone surfaces for the artificial joint components and attach them to the bones on each side of the joint. Once the artificial joint is properly fixed in place, the surgeon closes the incision. 

Post-Operation: You will go to a recovery room where you will be monitored. When you wake up, your foot will be in dressing. Later, it will be placed in a cast or a boot. You will stay in the hospital until you can walk safely, using a walker, cane, or crutches as needed. You will need to have your foot elevated as much as possible since this will help reduce swelling and improve wound healing. 

Rehabilitation: After your sutures are removed, your orthopedic surgeon will likely ask you to start simple movement weight-bearing activities, such as walking, while wearing hard-soled shoes to ensure proper healing. It may take up to eight weeks for you to be able to regularly bear full weight on the toe. Some patients may work with a physical therapist after great toe replacement surgery to improve range of motion and aid in recovery. 

Risks and Complications: As with any surgery, there is a risk of infection or blood clots. 

Summary: You should seek out an experienced orthopedic surgeon to perform your great toe replacement. This clinician should not only be skilled at performing the surgery but also have the ability to accurately assess the extent of the damage prior to surgery.