Bunion Surgery
Toe arthritis is caused by inflammation of the toe joint. The disease most often attacks the big toe, but the others may be affected as well. Past injuries or traumas, such as a broken or sprained toe, can cause arthritis later in life. Osteoarthritis, rheumatoid arthritis, and gout may also be contributory factors. There are three main procedures for performing this surgery and a brief description of each follows…
Dorsal Cheilectomy
This surgical procedure involves the removal of a bony prominence that is causing pain. This is normally due to pressure from the bony prominence against your shoe or because of irritation to the joint. Often there is a cause behind the development of the bony lump – this could be due to previous trauma, sport or in many cases, arthritis in the big toe.
The operation is under local anaesthetic (you are awake but the foot will be numbed via a series of injections around the ankle) so you can have a light snack before the procedure and the operation usually lasts about 30 minutes.
Joint Replacement
When conservative treatments or smaller surgical procedures have not been able to resolve big toe stiffness and / or arthritis or when the joint is severely damaged your consultant may recommend toe joint replacement.
Your consultant will make a small incision near your big toe joint. They will examine the current damage to the joint and any bony lumps will be shaved smooth. They will use a “prosthetic replacement joint” made of metal or plastic to replace either parts of, or your entire toe joint. The choice of prosthesis and extent of your surgery will depend on the severity and complexity of an individual’s condition.
Big Toe Fusion (Arthrodesis)
The word “arthrodesis” is the term for surgical immobilisation of any joint by fusion of the bones, and in this case, we are dealing with the joint of the big toe. This procedure will most likely be to correct a severe arthritis which is likely to be combined with a certain level of deformity.
In this case the surgeon makes an incision (cut) on top of the big toe, removes the damaged joint and bone, and then attaches the two bones at the re-aligned joint with screws and a plate.
Nanofracture
The Nanofracture procedure is the most advanced for of a surgery commonly known as a “microfracture” procedure offering a smaller, deeper, more effective solution.
Articular cartilage covers the ends of bones in joints throughout the foot and ankle complex. Normal cartilage is smooth allowing easy gliding of the joint. When the cartilage is injured, the smooth surface can become rough. On occasion, the cartilage injury exposes the underlying bone. Microfracture is a technique that can be used to treat an articular cartilage injury or defect that exposes bone.
This procedure can be performed on most major joints. It is an arthroscopic (keyhole) procedure using a small sharp pick to create a network of holes in the bone at the base of the articular cartilage injury. These holes allow blood into the injured area to form a clot. Over time, this clot turns into organised tissue called fibrocartilage which fills in the injured area. This tissue functions similar to native cartilage to restore joint function and minimize symptoms such as pain and swelling.
