Treatments of the Big Toe

A bunion (also known as hallux valgus) is a misalignment of the knuckle of the big toe. This misalignment causes the big toe to turn toward the smaller toes. It often creates a bump at the base of the big toe. Bunions are not always painful, but this deformity generally will increase over time.

A Chevron osteotomy is a common bunion correction surgery. The foot and ankle orthopaedic surgeon cuts the end of the long bone leading to the big toe (metatarsal) and rotates the end of the bone to straighten the big toe. This procedure may be performed in conjunction with soft tissue adjustments around the joint. This osteotomy is mostly performed for mild to moderate bunion deformity. This bunion correction surgery relieves pain by restoring normal straightness to the first toe joint.

Most bunions can be treated without an operation, but sometimes surgical procedures are needed to relieve pain and deformity. Unfortunately, in some cases bunion repairs fail and the pain or deformity returns. There are multiple factors that can contribute to this challenging scenario. Bunions can recur because of medical conditions or non-healing of the bone after surgery. In some cases, there are technical aspects that can be improved to achieve the desired result with additional surgery.

The goal of correcting a failed bunion repair, using a procedure called revision surgery, is to relieve pain and deformity of the first toe that remains after the initial surgery. Sometimes arthritis develops after bunion surgery. This may require a different procedure than the first. It is important to figure out why the first surgery failed to prevent another failure.

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP cheilectomy is a surgical procedure that removes bone spurs on the top surface of the big toe joint. Bones spurs develop due to arthritis of the big toe, also known as hallux rigidus. The spurs block the toe’s motion, which causes pain. A first STMP cheilectomy relieves pain and improves range of motion in the big toe.

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint fusion is a surgical procedure to treat arthritis of the big toe. This condition can cause pain and swelling and lead to difficulty walking, running, and wearing shoes. Arthritis develops when the cartilage on each bone wears away and the two bones that make up the big toe joint rub against one another.

In a first MTP joint fusion, the bones are joined (fused) together permanently so they cannot rub against each other and cause pain. 

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint interposition arthroplasty is a surgical procedure to treat arthritis of the big toe. The treatment can stop pain at the base of the big toe by preventing the surfaces of the bones from rubbing together. It also can preserve some motion in the big toe.

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint replacement treats arthritis of the big toe. The bone on either side of the joint is partially removed and replaced with metal, plastic or a combination of both. First MTP joint replacement lessens pain, retains motion, and improves the position of the big toe.

The first MTP, also called the first metatarsophalangeal joint, is the big toe joint. A first MTP joint resection arthroplasty treats arthritis of the big toe. This procedure stops pain by preventing the surfaces of the big joint of the big toe from rubbing together. 

First MTP medial capsulorrhaphy is a procedure that tightens the soft tissue on the inner side of the big toe joint. This procedure is done along with other procedures to help correct a bunion deformity. It should not be performed alone due to the likelihood of the bunion returning. Bunions involve both an altered position of the bones of the foot as well as a stretching of the soft tissue around the joint, which allows the big toe to turn inward toward the second toe. Both of these should be addressed to allow long-term correction of a bunion.

The goal of tightening the soft tissue is to restore normal tension of the previously stretched out tissue, aiding in pain relief pain by straightening the big toe. Bunion procedures also may improve the cosmetic appearance of the foot but should not be done for this reason alone.

A flexor hallicus longus (FHL) tendon transfer to the proximal phalanx of the big toe is used to treat clawing of the big toe.

Small muscles in the foot help to stabilize the big toe. When those muscles are weakened by disease, an imbalance occurs that leads to clawing. The clawing puts abnormal pressure on the ball of the foot that can cause an ulcer to form. In addition, clawing may lead to pressure on top of the toe from shoes. Clawing is associated with a variety of underlying disorders, including Charcot-Marie-Tooth disease, diabetic neuropathy, traumatic brain injury, polio, and stroke.

The primary goal of an FHL tendon transfer is to decrease the abnormal pressures on the big toe. This will prevent ulcer formation, or in the case of an existing ulcer, promote healing. An FHL tendon transfer often is done at the same time as other foot procedures.

The flexor hallicus longus (FHL) is the primary flexor muscle of the big toe. It originates at the back of the leg, transitions into a long tendon as it enters the foot and attaches on the bottom of the big toe.

The peroneus brevis (PB) muscle starts in the leg and continues along the outside of the ankle. It then takes a sharp turn and ends on the outside of the foot. The peroneus brevis works with the peroneus longus (PL) to turn the ankle and foot outward. 

The FHL to PB tendon transfer is a surgery to improve the function of the foot. The FHL is passed behind the ankle to the outside of the foot to either assist or replace the damaged PB tendon.

The goal of this surgery is to restore the power of the ankle and foot to turn outward, which is required for cutting and turning movement.