What is hallux limitus / rigidus?
Hallux limitus or hallux rigidus is the most common type of osteoarthritis to affect the foot and affects men and women equally in Australia. Patients with this condition often complain of pain and progressive stiffness at their big toe joint which is exacerbated upon moving the toe upwards. Pain occurs at the joint primarily from bony spurring at its top surface which blocks the toe from moving properly, in conjunction with loss of cartilage at the joint surface. As the condition progresses, the joint usually becomes stiffer as the remaining cartilage wears away, and the pain becomes constant regardless of activity.
Treatment of hallux rigidus
Early diagnosis and intervention for hallux limitus / rigidus generally leads to a better prognosis for patients as the condition is known to be progressive. Treatment often involves a combination of non-operative measures such as local cortisone injection, oral anti-inflammatories, custom orthotics, footwear changes, in conjunction with surgical management.
If the condition is diagnosed early enough, patients may benefit from a procedure known as a cheilectomy that is performed to clean up the joint, preserve any remaining healthy cartilage and keep the toe moving. As the condition progresses and there is further cartilage loss, cleaning up spurs from around the joint usually has little to no effect on pain levels and many surgeons often advocate to surgically fuse the toe. Although this procedure can provide good pain relief, fusion often causes secondary mechanical overload issues to develop in the foot and is undesirable in certain patients for example women who are never able to wear high-heels again as their toe no longer bends.
Cartiva for hallux rigidus: Eliminate pain, keep your toe moving and avoid fusion
Cartiva is a revolutionary synthetic cartilage graft, the first of its kind, approved for the treatment of hallux limitus/rigidus in Australia as of January 2019. This procedure has helped to fill the gap in surgical treatment for hallux rigidus, as an intermediate solution for those patients whose joint disease is too advanced for a cheilectomy procedure, but do not want a fusion. Cartiva acts as a 'buffer' for the big toe joint, in patients who have lost significant cartilage from the joint surface. The small synthetic graft is inserted into the head of the metatarsal bone where the cartilage has been lost, to allow for the toe move up and down without causing friction from bone-on-bone contact. The procedure is quick and simple, with no screws or plates involved and takes approximately 45 minutes to perform.
Cartiva boasts a 93% patient satisfaction rate in 6-year follow-up studies and has helped thousands of patients across the world reduce pain from hallux rigidus without sacrificing movement. A live x-ray video of a patient from our practice before and after the Cartiva procedure which illustrates this is shown at the bottom of this page. For more general information on Cartiva and its supporting literature please see: https://www.cartiva.net/
Recovery after Cartiva Procedure
A typical patient journey after the Cartiva procedure at our practice is documented below for reference. Please note that these milestones are taken as an average and some individuals may take longer to recovery from surgery.
1st post-op day to 1 week - Dressing and post-op sandal in place. Rest and elevate foot. Restrict activities to home only.
1 week to 2 weeks - Dressing changed at 1 week. OK to stand up to 20mins/hour. Continue to minimise time on feet.
2 weeks - Stitches removed. Transition back into sneakers. Apply compressive bandage and commence range of motion exercises. Upper body exercise only.
2-3 weeks - Return to work OK if office based. Driving short distances OK. Low-impact exercises OK.
4 weeks - Progress review with surgeon. Implant position will be examined. Patients OK to put full load through toe. Continue compression.
8 weeks - Progress review with surgeon. Implant position will be examined. Higher impact exercises OK. Continue compression. Return to wedged shoes/small heel OK.
12 weeks - Progress review with surgeon. Activities generally unrestricted. Minimal swelling at this time usually.
X-rays demonstrating post-Cartiva procedure with decompressive Moberg osteotomy of proximal phalanx.
Case Patient: Before Cartiva Procedure
Live x-ray imaging of 1st metatarsophalangeal joint demonstrating restriction in movement from hallux rigidus prior to Cartiva procedure.
Case Patient: After Cartiva Procedure
Live x-ray imaging of 1st metatarsophalangeal joint demonstrating significant increase in movement after Cartiva procedure.
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This website is intended for general information purposes only. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.