Wear and tear at the joint of the midfoot and the great (big) toe cause loss of cartilage and the smooth movement of the joint. As the smooth joint surface is lost this becomes painful and movement restricted.
If these methods of symptom control do not work then an injection of local anaesthetic and steroid into the joint may be helpful. If so I would perform this in theatre to reduce the risk of infection.
If the pain you get is mainly over the top of your big toe joint, and worse on bending your toe up, you may benefit from the removal of the excess bone that the body has made in response to the arthritis. This is done through a cut over the top of the toe or through a very small cut at the side of the toe (minimally invasive surgery) and helps to increase the range of movement, stops pressure from the excess bone against your shoe, and decreases the trapping of the joint lining between the excess bone. This operation is only good for certain levels and types of 1st MTP arthritis.
There are many cases of big toe arthritis which are too severe for cheilectomy. Of these some are suitable for a motion preserving implant - the Cartivia. The patient information leaflet can be downloaded here. Mr Machin will discuss your suitability for this at your appointment.
With a fusion the damaged and worn out joint surfaces are removed using special tools that allow the two bones to be pulled very close. These two bones are then held with a plate and should fuse together to become one. The operation is usually performed through an incision over the top of the joint. The plate and screws are usually left in and cause no problems.
All surgical procedures carry some risk. These risks are usually rare, but can include infection, bleeding, damage to surrounding structures such as tendons or nerves, numbness, dysfunction of foot, ongoing pain, unsightly scar, painful scar, wound healing problems, swelling. There is also a risk that the procedure does not work fully and that the patient is left with some ongoing symptoms.
There are also some medical risks to surgery such as a clot in the leg (DVT), clot in the lung (pulmonary embolus or PE). The general anaesthetic has rare risks of problems such as heart attack, stroke, chest infection and in extremely rare circumstances, death.
Continued pain and stiffness, may require a fusion in the future.
There is a small chance of the bones not fusing together and this is called "non-union". Smoking and diabetes increase this risk. If this happens you may need further operations to deal with the problem. Occasionally the plate and screws can become prominent and need removing through the same incision at a second operation.