Big Toe Prosthesis

What is a big toe joint prosthesis?

When a joint is damaged by osteoarthritis, there is a loss of cartilage with increased mechanical stress on the bone. Osteoarthritis may present as painless stiffness of the hallux metatarsophalangeal joint, but it can also cause pain that may be disabling.

In case of painful functional limitation, it is possible to perform surgery on the metatarsophalangeal joint of the big toe. When the joint can be preserved, it is possible to offer joint release by performing an arthrolysis and then resecting the bony spurs responsible for conflicting pain. This involves trimming with a cheilectomy.

If the joint can be preserved but with predominant joint pain, we can offer decompression surgery by performing what is called a metatarsal or even phalangeal osteotomy.

It is also necessary to correct any associated deformity in order to stabilize the joint in cases of hallux valgus combined with hallux rigidus. This type of pathology is referred to as hallux rigido valgus.

When the joint is too damaged by osteoarthritis and can no longer be preserved, two surgical options can be considered. The first consists of the placement of a metatarsophalangeal prosthesis, which replaces the affected joint while maintaining some mobility.

This residual mobility can be especially beneficial for sports activities or for wearing shoes with heels of varying heights. The second option, arthrodesis of hallux rigidus, consists in permanently fusing the bones of the joint to eliminate pain, at the cost of total loss of mobility.

The different types of prostheses

There are different types of prostheses for the hallux or big toe:

• Joint prostheses
• So-called removable prostheses
• Nail prostheses

Metatarsophalangeal joint prostheses of the hallux or big toe

There are two main types of prostheses for the big toe joint: hemiarthroplasties, which replace only one side of the joint, and total arthroplasties, which replace the entire joint. Hemiarthroplasties can lead to pain and functional limitations. Interposition arthroplasties can be either biological (using natural tissues to restore joint movement) or mechanical (metal or ceramic implants), each with its own advantages and disadvantages in terms of mobility, stability, and complications.

Currently, a pyrocarbon prosthesis is preferred for its biocompatibility, elasticity close to that of bone, and its ability to optimally distribute stresses without integrating into the bone.

Nail prostheses for the big toe

Following trauma, a fungus, or trophic disorders, the nail of the big toe may become very unsightly. In this case, it is possible to use a removable prosthesis which restores the aesthetic appearance of the foot.

Removable prostheses

In case of uncontrolled diabetes, serious trauma, or severe vascular problems, amputation of the big toe may be performed.

In this case, a removable prosthesis can be used to restore the foot’s appearance. This device is custom-made.

Big toe surgery

We specialize in so-called articular prostheses, metatarsophalangeal prostheses, and we use a spherical pyrocarbon implant. This procedure may be considered in cases of:

• Hallux Rigidus
• Metatarsophalangeal osteoarthritis
• Revision of an arthrodesis

Failure of fusion in an arthrodesis can cause pain, which is called a pseudoarthrodesis. Some pseudoarthrodeses can be re-operated on to place a spherical pyrocarbon prosthesis. Some arthrodeses may remain painful despite successful fusion. In this case, we may consider undoing the arthrodesis and performing a prosthesis, known as prosthesis disarthrodesis.

Postoperative care and rehabilitation after prosthesis placement

The postoperative course following a big toe prosthesis requires specific management. Weight-bearing is generally allowed as early as the day after surgery with an appropriate therapeutic shoe. Rehabilitation begins early to optimize the recovery of joint mobility.

Pain control after the operation is managed with appropriate painkillers. Regular wound care is necessary until complete healing, which is generally achieved within 2 to 3 weeks. The resumption of sports activities is gradual and depends on the type of prosthesis implanted. For athletes, a specific rehabilitation protocol is established to optimize the return to activity.

Expected results and possible complications

The results of big toe prostheses are generally satisfactory, with a significant improvement in pain and function. The recovered joint mobility allows for wearing normal shoes and participating in moderate physical activities.

As with any surgical procedure, complications may occur: infection, joint stiffness, loosening of the prosthesis, or premature wear. However, the rate of complications remains low when the indication is well established and the surgical technique is rigorous. Regular follow-up by the surgeon allows early detection of possible complications and helps optimize the longevity of the prosthesis. Control X-rays are performed at regular intervals to monitor the implant.