What are the options of treatment?

Non-surgical treatment

• Non-steriodal anti-inflammatory drug (NSAID) such as ibuprofen may help reduce the active swelling and pain relief.
• Ice packs or taking contrast baths may help for a short period of time.
• Shoe modification with a widen toe box to accommodate the bump, stiff-soled shoe with a rocker bottom design may help to prevent bending force on the joint. Orthotic with a steel shank or metal brace in the sole can be measured with similar action. These are not effective to stop the condition from progressing but just symptomatic relief.
• Injections – a. Steroid, b. hyaluronic acid.

Surgical treatment: Different types of surgical treatment are commonly practiced depending on the clinical examination and radiological grading of degeneration.

• Cheilectomy operation: This is a simple operation to remove the osteophytes that limit the range of motion. It improves range of motion for wearing higher heel shoes or for running, and, though it often reduces pain, this is not guaranteed. It takes 3 months to recover 80% and 6 months to fully recover. Naturally, this does not alter the natural history of the underlying problem of arthritis; it merely reduces the pain from impingement of the osteophytes, which are caused by the arthritis. The potential problem is risk of further joint degeneration and require further surgical procedure, it is however a buy-time procedure.

• Autologous interposition arthroplasty: It is using a free ipsilateral gracilis tendon graft is for patients with severe hallux rigidus with moderate to high activity levels and who do not wish to undergo fusion.

• Fusion operation. This is a procedure to remove the joint and join the bones of the foot and toe together. This reliably removes pain and allows one to return to running.This is a procedure indicated for those with pain due to both bony spur and the joint. It is a more assuring procedure as the diseased joint is converted to a stable one-piece bone. The trade-off is the big toe become stiff, but we usually fused it in a physiological position for walking. A plate and screws are used to stabilize the fixation for the bone surface to heal by 6-8weeks.

• Arthroplasty (excision of the whole joint +/- replacing with a spacer or an artificial prosthesis) is a joint replacement, which significantly reduces pain and allows good function. It may have a limited life of approximately 10 years and require revision or a fusion operation later. This is an alternative procedure to arthrodesis for those older people who place few functional demands on the feet. It is not well accepted as the potential risk of prosthesis complications eg. wear, dislocation, loosening, etc.