*Surgical Photos Included in this Article*




You may have seen other articles or blogs on our website about arthritis of the great toe joint or 1st MPJ which is called Hallux Limitus or Hallux Rigidus.  And many people have asked me what this actually looks like on the inside.  This article is designed to show you exactly what arthritis looks like and explain why we cannot always save your joint and an implant or fusion is necessary.  

Briefly, arthritis of the 1st MPJ or great toe joint is caused from trauma or mechanical instability of the mid and forefoot causing a constant jamming effect of the joint.  Overtime, this joint starts to erode, the cartilage breaks down and a bone on bone effect of the joint occurs.  This causes the joint to become much bigger than normal because of excess bone spur formation.  In the Xray below, you will notice that the 1st MPJ is much different from the others.  it is larger, darker and there is no joint space as there is in the joints next to it.

hallux limitus preop


 In the picture below taken during surgery, you can see no actual cartilage in the joint.  It has what we call a "cauliflower" appearance with no smooth surface.  it's very "lumpy-bumpy" which does not make for good joint motion.  In fact, this patient had very little motion of the toe and when it did move, it was quite painful.

intra op picture of arthritis

Once the excess bone is removed, the implant is inserted and acts like a normal joint surface.  As with all of these cases, not only is the 1st MPJ significantly changed, but so are the sesamoid joints.  These are 2 small bones that sit under your big to joint that help with motion.  These must be freed of their scar tissue but very little can be done to change the arthritis at this joint.  This arthritis does limit the amount of motion you will get with the implant, but in the long run is usually not a problem.

In the photo below you will see what the implant looks like once it has been inserted in the metatarsal head.  Note that all excess bone has been removed and it is now a normal size.

intraop implant

The xrays below show what the implant looks like when everything has been completed.

post op X-ray implant    post op X-ray lateral implant

This procedure is performed at a surgery center or hospital as an outpatient procedure.  You wear a post op shoe for approximately 3-4 weeks and begin moving your toe at the 1st post op visit.