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Toe joint replacement surgery is an elective procedure that can improve mobility and quality of life for people with painful toe problems. Rheumatoid arthritis, osteoarthritis, or direct trauma to the big toe can cause constant discomfort and make it difficult to enjoy daily activities. The procedure involves removing damaged bone and cartilage tissue and fitting a plastic or metal artificial joint into place. The most common site for toe joint replacement is the metatarsophalangeal (MTP) joint, the structure at the base of the big toe. Most patients who have the surgery are able to make excellent recoveries and return to normal activity levels within a few months.
Not all MTP conditions necessitate surgery, and a podiatrist usually tries to fix problems non-surgically first. Anti-inflammatory drugs, arthritis medications, and splinting are typical first-choice treatment options. If a person still cannot walk comfortably, the podiatrist can explain toe joint replacement and answer any questions about the procedure. Most podiatrists are qualified to perform the surgery in their offices, though a patient may be directed to a specialty surgical center instead.
Before toe joint replacement, the surgeon usually injects a localized anesthetic into the foot. The top of the toe is shaved and washed, and an incision point is chosen along the base of the MTP joint. The surgeon makes a small cut and investigates the extent of cartilage and bone damage. When possible, only half of the joint is removed and replaced with a metal prosthetic while the other end is simply smoothed and reattached. Total toe joint replacement is a more difficult procedure that involves fitting a custom artificial joint while avoiding accidental damage to tendons, nerves, and blood vessels.
Once the joint is in place, the podiatrist sutures the surgical wound and helps the patient into a recovery room. A nurse dresses the scar and makes sure the anesthesia wears off before the doctor returns for a checkup. He or she makes sure the joint stays in place and that the patient is in minimal pain. A splint, hard cast, or special protective sock may need to be worn for several weeks to give the toe time to heal. Most people are advised to use crutches and avoid bearing weight until it is time for the cast to be removed.
Once the toe heals, the podiatrist can arrange for physical therapy sessions. The patient is instructed to perform light stretching and bending exercises to build flexibility and get used to the feeling of the prosthetic. After about two months, most patients can comfortably walk and run again.