Arthritic Big Toe

The Sklar Bunionectomy | www.footfirst.com

A common condition that we treat here at Foot First is arthritis of the big toe, also called hallux limitus or rigidus.  In our practice we lovingly call this deformity an arthritic bunion.  It is commonly caused by genetics, however it can sometimes be precipitated by an injury to the joint.  These types of patients often have a large lump at the top of their big toe, as opposed to the side like in a traditional bunion.  Depending on how severe the arthritis is, the joint may be stiff or not move at all.  The pain most people experience is over the lump, within the joint, or on other parts of the foot because the joint does not move like it should.  The purpose of this post is to give you a basic understanding of what doctors have to offer in the way of helping a patient.

There are two types of procedures that can be performed for an arthritic big toe joint.  The first is joint salvage.  Joint salvage procedures have the goal of surgically improving the joint without removing it.  These procedures include removing the bone spurs (Cheilectomy), joint decompression, and/or joint realignment.  Removing the bone spurs can offer comfort if a patient is only having pain around the bump over their big toe, however if they are having joint pain then joint decompression and realignment are also necessary to improve the pain.  The advantage to these procedures is that they allow for mobility of the joint so it can keep functioning normally and it is less invasive.  The disadvantage to these procedures is that the joint still remains so it is possible to produce more arthritis in the patient’s lifetime.  The doctor or the patient will know how fast this will happen, if it does, but generally these are successful long lasting procedures for most people.

The second type of procedures are called joint destructive procedures.  These most commonly include joint fusion or joint replacement.  Joint fusion is when the cartilage is removed from the joint so it can heal together where the joint will never move again.  It is hard for most patients to believe, but most people can live very normally without that joint.  Joint replacement procedures remove the cartilage, like in a fusion, but a prosthetic joint is inserted.  The disadvantages to these procedures are that they are more invasive and more permanent.  For instance, if the patient is unhappy with these surgeries, there are much more limited options when it comes to revision as there is no more joint to work with.  The advantage to these surgeries is that since they remove the joint there is no more chance for arthritis to reoccur.  

A patient can also attempt conservative therapy if they aren’t ready for surgery.  Some different types of treatments include ice, NSAIDS, orthotics, physical therapy, change in shoes, PRP injections, and cortisone injections.  At our practice we have a lot of success with change into Hoka brand shoes, and cortisone injections.  Cortisone works to decrease the inflammation around the joint greatly reducing pain and swelling.  This combo can buy some patients months to years before they elect to have surgery.

If a patient elects to have surgery in our practice we almost always turn to our joint salvage Sklar Bunionectomy.  Our procedure is revolutionary in the fact that it both decompresses and realigns the joint without shortening the big toe.  When the big toe is shortened it can be cosmetically displeasing, but also put more pressure on the ball of your foot causing further pain.  With our procedure there are also no visible scars.  Our incision is hidden on the side of the foot which again, provides a functional and cosmetic advantage.  When the scar is on top of the foot it creates scar tissue across the joint.  This can undo the motion that the surgeon is trying to give the stiff big toe joint in the first place.  This works against the goal of surgery.  Lastly, our procedure allows you to step on your foot right away, and return to a gym shoe in 2-3 weeks.  No cast or crutches are necessary.  There is no exercise on the surgical foot for 8 weeks from surgery.  

No matter how bad your arthritic bunion pain is, we are ready to help!  If you would like a consultation regarding this issue please use the contact us form on our website or give the office a call at 847-352-9221.  

Long, short, curled or even just plain ugly toes? At Foot First we can fix that!

Before & After results with the Sklar Bunionectomy & Toe Shortening Procedure

Long toes can be troublesome for a patient for many reasons.  Toe shortening is a unique procedure that we perform alone, or along with our bunion surgery, the Sklar Bunionectomy™.   

Toe shortening has a similar recovery to our bunion surgery where you are able to weight bear immediately, and get back into a gym shoe in a short amount of time.

You may wonder why some people request to have their toes shortened.  Long toes can be problematic not only cosmetically, but also functionally.  A long toe extends past the other shorter toes so it may hit the end of the shoe first, causing the toe to curl and jam.  This can cause a hammertoe over time, or a painful corn on top of the toe as it rubs on the shoe. The constant jamming at the end of the shoe can also cause the toe to dislocate over the metatarsal bone.  This causes a painful callus on the ball of the foot. This also occurs when the metatarsal bone behind the toe is too long as well, and would require an additional procedure to the toe shortening to fix.

If you have a bunion along with long toes, we always correct the bunion with the toe shortening procedure.  This is because if we do not correct the bunion deformity, the big toe pushes against the smaller toes as they heal.  This eventually causes them to heal crooked, or become crooked over time. This is why we always address the bunion deformity as well.  The image to the right is a patient who had her toes shortened by another doctor without fixing her bunion. We then had to correct her bunion along with her crooked toes.

During our initial consultation we determine which toe shortening procedures you need by where you are feeling pain, and with X-rays of your feet.  We also determine how much you want your toe shortened. You tell us approximately where you envision your shortened toe to be in comparison to the other toes.  For instance, some patients still want their second toe to be in line with the big toe, or some patients want their second toe to be shorter than the big toe. This is where the surgery becomes more of an art than a science, because everyone has a different opinion of what they consider beautiful.

Surgery for toe shortening is done under local anesthesia (awake with numbing of the toes) or twilight anesthesia (asleep) through a small incision on the side of the toe.  We remove a section of bone that we determine before surgery. How much bone we remove will depend on how much your toe needs to be shortened. We then insert a wire to hold the toe while it heals.  The wire will be underneath the skin and will NOT stick out the ends of your toe. The wire is not meant to be permanent and will need to be removed at a later date. We then close the incision usually with only one stitch, and allow you to recover.

After toe shortening surgery patients usually experience pain for three days.  They are able to weight bear immediately and are wearing a surgical shoe. Patients wear the surgical shoe for three weeks, and also have to keep the foot clean and dry during that time.  At three weeks the sutures will be removed and patients will be allowed to wear a gym shoe. At 8-12 weeks, depending on how the bones are healing, we will numb the toes to remove the pin inside of the toe.  Then patients are allowed to return to exercise like running, jumping, and wear different shoes.

Toe shortening surgery is very successful, although it will never be perfect.  Healing is determined by the success of the surgery, genetics, and compliance with instructions all combined.  With all the surgeries we tell our patients that toes will cosmetically look ugly for 4-6 months before they start to see their true result.  This is how long it takes for most patients’ swelling to come down. Some more serious complications of toe surgery are, but not limited to, floating toe, crooked healing, creases/scarring to the skin, a swollen toe, numbness, or a toe that is painful.  Usually if we work together by us performing good surgery, and the patient follows instructions and genetically heals well, we all end up with a beautiful result.

Our unique toe shortening procedure offers patients the chance to lessen their pain, and have a beautiful looking foot.  Our before and after pictures showcase our most beautiful results. As stated before, toes take 4-6 months on average to become beautiful.  All after photos posted are usually taken at 6 months to 1 year after having toe shortening surgery.

For more information about our unique Toe Shortening procedure or to view additional before and after results, visit www.footfirst.com.