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What is a Toe Joint Replacement?

By D. Jeffress
Updated Mar 03, 2024
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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.

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Discussion Comments
By anon1001029 — On Feb 19, 2019

My doctor fused the joint in my second toe more than a year ago. It is still very painful, and makes walking and going down stairs difficult. Is there any chance of having a joint replacement done on a toe with a fused joint?

By anon286881 — On Aug 22, 2012

I am at week four after joint replacement. At this point, I would have to say that the surgery was a success. I am back at work full time and wearing shoes (ones with a wide toe box and not very fashionable, but shoes none the less!)

I spent the first two weeks after surgery not doing too much, the next week wearing a boot and back at work part time and this week not only have I gone back to work but also have been to my gym to ride a bike and walk slowly on the treadmill.

The overall pain after the first couple of days was minimal, and now I just have slight discomfort. If you qualify for replacement, this is a much better option than fusion.

By stoneMason — On Jul 09, 2012

@literally45-- I don't quite agree with @burcinc. I'm no expert on this and I do think that your doctor is the best person to talk to about the risks and benefits of each procedure. But as far as I know, both fusion surgery and toe joint replacement have the potential to fail. The only difference is that a fusion is permanent and should be done as a last resort.

It also depends on how badly damaged your joints are. For people who are still at the beginning of degenerative diseases and whose big toe joints are still somewhat flexible and mobile, toe joint replacement is a better option. When the joint is in very bad condition and has lost mobility completely, then doctors will consider a fusion. A fusion also takes a lot longer to recover than toe joint replacement.

By the way, swelling and stiffness is very common initially after big toe joint replacement. The swelling can last up to a year even. This is not a sign that the surgery has failed.

By burcinc — On Jul 08, 2012

@literally45-- I had a toe joint replacement last year which failed. My toe was still stiff, swollen and painful three months post surgery. I couldn't walk without limping and I couldn't bend my toe at all.

Then I had the fusion done, it's where they fuse the joint together into one. It makes the toe permanently stiff, but has a higher success rate than toe joint replacement.

My fusion surgery was very successful and I'm back up on my feet and pain free ever since.

By literally45 — On Jul 08, 2012

I have toe joint pain and immobility in both of my toes because of arthritis. My doctor wants me to have toe joint replacement done. He thinks that I will be much better off with it.

However, I've been reading online comments by people who have had this surgery and some of the comments have really scared me. There were several people who said that the surgery failed for them and they had to go back in for a second surgery.

Does anyone know what is the success rate of toe joint replacement? What are the chances that it will go wrong and I will have to have surgery again?

As far as I know, the alternative to this procedure is something called a fusion. Which operation is better and more successful?

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