I am a former ballet dancer with my own studio now. My biggest problem is pain at the base of the big toe on my right foot. I can hardly rise up on my toes any more and that's an important movement for demonstrating dance steps. I've been told fusing the joint is my only option. If I wait awhile, will they come out with a toe replacement any time soon?
The first metatarsophalangeal (MTP; base of the big toe) joint implant was tried back in 1952. Surgeons continued to modify implant designs to get a functional unit. But as you can imagine, with the weight of the body behind every footstep, an artificial joint at the base of the big toe doesn't hold up very long.
The natural anatomy of the big toe is complex enough to make duplication with an implanted joint difficult at best. For example, two tiny bones called sesamoids just under the joint support and cushion the toe in a way that an implant hasn't been able to reproduce.
Until recently, arthrodesis (fusion) of the joint has been the favored treatment. Patients suffering pain and joint destruction from trauma, gout, arthritis, and other conditions (e.g., deformities, bunions) have had success with arthrodesis.
With an arthrodesis procedure, wires, pins, and plates are used to fix or hold the joint in a locked or fused position. Fusion does limit motion at that joint, which in turn, causes changes in the way a person walks. Loss of motion at this joint can limit activities such as rising up on toes or running.
Total toe arthroplasty (another term for big toe joint replacement) is being developed. There are a couple of different designs available. Results so far comparing joint replacement with arthrodesis don't favor the arthroplasty.
Some patients do report decreased pain. But the overall satisfaction rate is only around 77 per cent after five years. That doesn't begin to compare with the 90 per cent rating for arthrodesis and up to 98 per cent rating for hip or knee replacements.
For those patients willing to try this approach, the implant can always be removed and the toe fused if it doesn't work out. But there is usually bone loss with this type of revision surgery, so it isn't done routinely.
You might want to consult with an orthopedic surgeon about the advantages and disadvantages of fusion versus joint replacement. Find out what your options are before making any decisions. Give yourself some time to think it through and weigh the pros and cons given your particular situation.
Nicholas A. Abidi. First Metatarsophalangeal Arthritis: Arthrodesis Versus Arthroplasty. In Current Orthopaedic Practice. May/June 2010. Vol. 21. No. 3. Pp. 258-263.
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