Stiff toe is a degenerative disease of the metatarsophalangeal joint of the toe, which is manifested above all by the inability to bend this joint, pain, swelling and inflammation in its area. Moreover, in more advanced stages, joint deformation is visible and – as a result of formation of abnormal layers of bone tissue (osteophytes) – the Patient experiences discomfort while wearing footwear. In most cases, deformation of the first toe (big toe) is insignificant.
Ailments appear as a result of degenerative changes in the first metatarsophalangeal joint, i.e. damage to articular cartilage and appearance of cartilaginous and bony outgrowths at joint edges, which limit the movement range and cause pain.
The disease appears in families (genetic factor), on the ground of changes caused by overloading as a result of excessive joint loading (hard physical work, obesity), in rheumatoid diseases (e.g. gout, articular cartilage diseases), after forefront injuries and idiopathically (when the factor stimulating development of the disease cannot be determined).
Surgical treatment is aimed at eliminating pain and an attempt to restore joint movability. The surgery is performed in the hypoemic area obtained by placement of a compression band over the thigh.
Basic surgical treatment involves removal of bony outgrowths, releasing contracture of soft tissues around the joint and cleaning of the joint itself. In case of complete joint destruction (no articular cartilage), improving joint movability will not reduce, but actually increase the pain. In such cases, the damaged joint may be replaced with an endoprosthesis or stiffened. Implantation of the endoprosthesis reduces pain and lets achieve satisfactory joint movement. Stiffening of the metatarsophalangeal joint relieves pain, but makes the joint completely immovable.
The decision regarding surgical treatment of the stiff toe must be made on an individual basis; in addition to the degree of joint damage, physical activity and expectations of the Patient must be taken into consideration.
Performance of the surgery itself does not guarantee elimination of the ailments suffered so far. The final treatment effect is closely related with observing the doctor’s recommendations and undergoing the full cycle of rehabilitation treatments, adapted to the individual needs of each Patient.
After the surgery
- Before the surgery, the Patient ought to ensure transport back home – the Patient should not drive the car or use public transport.
- The Patient ought to purchase prescribed medicines and take them as recommended by the doctor.
- Dressing changes ought to be performed as recommended by the doctor. Avoid making the wound wet.
- Foot swelling and pain in the operated area appears after the surgery. To mitigate swelling, reduce walking and keep the leg in a raised position. Pain can usually be controlled with prescribed medicines.
- The follow-up visit ought to take place as scheduled but, in case of reddening, liquids leaking from the wound, fever, increased pain and swelling, please contact the doctor.
- Partial loading of the operated limb (pressing the heel against the ground) is usually allowed. The Patient may also purchase a special shoe available at medical stores. To facilitate walking, use of elbow crutches is allowed.
- The period during which the operated foot ought to be spared differs on the kind of surgery performed, from 3 to 12 weeks.
- After the surgery, the Patient must soon begin rehabilitation – both in the form of exercising (increasing the scope of movement, stretching of developing scars), and physical therapy (laser, magnetronic, iontophoresis) to support quicker wound healing and loosening of scars. Rehabilitation is painful.
- After implantation of an endoprosthesis, exercising begins during the second day, whereas full loading is allowed after 3 weeks.
- If the joint is stiffened, the forefront must be unburdened (the Patient ought to walk in an orthosis) for 6 weeks, with full loading possible after 12 weeks.
Side effects and complications
Performance of any medical intervention involves the risk of side or adverse effects.
These may include body temperature increase after the treatment, temperature increase in the operated joint, reddening of the joint skin and of the surgical wound area, separation of the wound, which is connected with a prolonged treatment process. Hematomas (skin bruising with local tenderness) appear in the surgical wound area. Painfulness appears for several weeks after the treatment, with the strongest pain experienced for 2-3 days after the treatment and after beginning of the rehabilitation process. Skin sensation disorders occur in the surgical wound area
The most frequent complication is swelling of the joint, which persists for several weeks and hinders rehabilitation. In terms of frequency, the second complication is swelling of the whole limb. This ailment is related to standstill in venous and lymphatic circulation, which may lead to vein inflammation and thrombosis which requires weeks’ long treatment and deteriorates rehabilitation effects. In some cases, a thick scar develops in the area where surgical cuts were performed. Pain and sensation disorders, including skin hyperesthesia, may appear in this area. A very rare complication is unplanned bone fracture or fracture of implants during the treatment. In occasional cases, vessels or nerves in the operated limb may be damaged or infection of the surgical wound may develop.
So-called late complications include development of scar changes within the surgical wound, including hyperesthesia and pain, and limited movability of the first metatarsophalangeal joint (big toe). In case of surgeries which require bone section, the bones may not knit, the endoprosthesis may become destabilised and another surgery may be needed.
The risk of complications is several times higher in case of emaciation or obesity.
Non-surgical treatment is mainly aimed at reducing the pain suffered.
- Analgesic and anti-inflammatory medicines administered generally (pills, suppositories) or locally (ointments, intra-articular injections).
- Physical therapy (ultrasounds, shockwave, laser, cryotherapy, iontophoresis).
- In case of diagnosis of systemic diseases – treatment of the reasons thereof.