Toe Joint Replacement

What is a toe joint replacement?

Toe joint replacement is surgery to remove a damaged toe joint and replace it with an artificial (manmade) joint. The replacement part, called a prosthesis, may be made of metal, ceramic or plastic. It’s manufactured to work like a normal, healthy toe joint.

The metatarsophalangeal (MTP) joint of your big toe is the toe joint that gets replaced most frequently. The first MTP joint connects your big toe to your foot. The joint must bend every time you take a step. If your MTP joint is damaged or stiff, walking can be painful.

Your big toe is sometimes called the:

• First toe.
• Great toe.
• Hallux.

Joint replacement is also called arthroplasty.

Why is toe joint replacement surgery done?

Toe joint replacement can treat certain conditions in your foot after all other treatment options have failed. First-line, nonsurgical treatment options usually include:

• Assistive devices, like special shoes or a brace to help you walk.
• Changes to your activity.
• Pain medications.
• Physical therapy.
• Steroid injections.

The most common conditions that can lead to toe joint pain are:

• Bunions (hallux valgus), painful bony lumps on the outside of your big toe.
• Hallux rigidus, or “stiff big toe.”
• Injury, like a bone fracture.
• Osteoarthritis, a degenerative joint disease.
• Osteonecrosis, when bone tissue dies because it doesn’t receive enough blood.
• Rheumatoid arthritis, an inflammatory disease that causes joint swelling and pain.

If all other treatment options have failed, toe arthroplasty may help:

• Relieve joint pain.
• Reduce stiffness and swelling.
• Restore function (usefulness) of your toe joint.
• Improve range of motion (the distance your joint can extend).

How common is toe arthroplasty?

Orthopaedic surgeons frequently perform arthroplasty for other joints like:

• Hip replacement.
• Knee replacement.
• Shoulder replacement.

Toe joint replacement surgery is far less common.

What’s the difference between toe joint replacement vs. fusion?

Joint fusion (arthrodesis) is surgery that permanently connects the bones that form a joint. It helps stabilize your joint and reduce pain. But after the procedure, your joint can’t move at all. After toe replacement surgery, you can still move the artificial joint. But the success rates for toe joint replacement can be different for everyone, and few people are candidates for a total joint replacement.

What happens before toe joint arthroplasty?

Toe joint replacement should be performed only by an experienced orthopaedic surgeon, preferably one who subspecializes in foot surgery. Before recommending the procedure, the bone and joint specialist will:

• Ask you about your general health and any medical conditions you have.
• Ask about your toe pain, how long it’s been happening and how it affects your life.
• Examine the toe for strength and range of motion.
• Order X-rays of your foot to get pictures of the bones involved.
• Perform other tests to make sure you’re healthy enough for surgery (for example, blood tests).

What happens during toe joint replacement?

Toe joint replacement is performed in a hospital or an outpatient surgical center. The procedure usually takes two to three hours.

The surgical team will:

1. Give you anesthesia through an IV in your arm to put you to sleep.
2. Make an incision (cut) on the top of your toe.
3. Remove the joint and any damaged cartilage and bone.
4. Insert the prosthesis.
5. Attach it to the bones on each side of your toe joint with pins, screws or bone cement.
6. Make sure your artificial joint is in place and secure.
7. Test that your toe joint moves appropriately.
8. Ensure that surrounding tissues — like tendons and nerves — are back in place.
9. Close the incision, usually with stitches.
10. Wrap your toe and foot in sterile bandages, then a cast.

What happens after a toe replacement procedure?

After surgery, you’ll wake up in a recovery room, and your foot will be wrapped. You may have a cast or a boot on your foot. Your healthcare team will monitor you to ensure you don’t have any side effects or complications from the anesthesia.

You’ll stay in recovery until you can walk safely with an assistive device like a walker, cane or crutches. Before you leave, your healthcare team will give you instructions on how to take care of your toe, which may include:

• Icing your toe to reduce pain and swelling.
• Elevating your foot as much as possible.
• Returning to get the stitches removed.
• Wearing hard-soled shoes as often as possible.

What are the pros and cons of toe joint replacement?

Your healthcare team will review the benefits and risks associated with toe joint replacement.

Benefits may include:

• Better range of motion in your toe and foot.
• Improved function of your toe and foot.
• Less stiffness and swelling in your toe.
• Pain relief.

Toe joint replacement complications are rare, but may include:

• Blood clots.
• Infection in your joint/prosthesis.
• Infection of the wound.
• Malfunction of the prosthesis (it can break, loosen or become dislocated).
• Nerve injury.

How long is recovery after toe arthroplasty?

Your healthcare team will encourage you to walk to use your new joint pretty soon after surgery. Exercise is an important part of your recovery. Although this may hurt at first, walking should become less painful over time.

Your surgeon may recommend physical therapy for toe joint replacement recovery. It can take as long as eight weeks to put full weight on your toe.

How should I take care of myself after toe joint replacement?

Some strategies may help you recover more quickly and safely:

• Arrange for someone to help you at home.
• Ensure that any tripping hazards are removed from your home (such as throw rugs and cords).
• Use assistive devices to keep weight off your toe (like a cane, walker, crutches, shower bench and handrails).

When should I seek medical attention after a toe joint replacement?

Call your surgeon if you notice any signs of infection, including:

• Fever or chills.
• Pain that won’t go away or gets worse.
• Pus or a bad smell coming from the incision.
• Redness or swelling around the incision.

Also, notify your healthcare team if you eventually experience signs that the implanted joint is failing, such as:

• Decrease in joint function or strength.
• Instability (feeling like it might give out).
• Pain.
• Stiffness.
• Swelling.

A note from Cleveland Clinic

If injury or arthritis causes constant pain in your toe, an orthopaedic surgeon may recommend toe joint replacement. Toe arthroplasty removes your damaged toe joint and replaces it with an artificial (manmade) one. The procedure can reduce pain when you walk.