For selected patients with hallux rigidus who want to preserve big toe motion rather than fuse the joint, a joint replacement or interpositional arthroplasty (a synthetic spacer or capsular tissue placed between the bones) may be considered. Generally reserved for less active patients or those for whom motion preservation is important.
ℹ️ This appointment takes place 2-4 weeks before surgery. The team will confirm that joint replacement, rather than fusion, is the best option for you.
You will meet the nursing and anaesthetic team. The relative merits of joint replacement vs fusion will be discussed in detail. Fusion is more durable, but replacement preserves motion.
Standard pre-operative checks.
Blood thinners may need to be paused.
Usually under regional ankle block with sedation, or general anaesthesia.
As with any joint replacement, untreated dental infections can seed bacteria to the new joint. See your dentist before surgery if needed.
Joint replacements in the big toe have higher revision rates than hip or knee replacements. Around 10-15% may need further surgery within 10 years.
ℹ️ You will be given a specific arrival time. Do not eat or drink (other than clear water up to 2 hours before) from midnight the night before. Bring your medication list and any documents sent by the hospital.
You will be admitted to the ward or day surgery unit, change into a gown, and be seen by the nursing, anaesthetic, and surgical teams before theatre.
Your surgeon will confirm the procedure, mark the operative side, and you will sign a consent form before going to theatre.
You will meet the anaesthetist in the anaesthetic room. Once anaesthesia is established, the procedure will begin.
After surgery you will wake in the recovery room where nurses monitor your vital signs until you are stable and comfortable.
Most foot and ankle surgery is performed as a day case, meaning you go home the same day. More complex procedures such as ankle replacement or flat foot reconstruction usually require 1-3 nights in hospital. Before discharge, the team will check your pain is controlled, give you wound care instructions, and confirm your follow-up appointment.
You will be given oral pain relief before discharge. Take it regularly for the first 48 hours rather than waiting until pain is severe.
A nurse will check the wound before you leave and explain how to keep it clean and dry.
You will be shown how to use crutches and given clear instructions about weight-bearing on your operated foot.
You will receive a letter for your GP and details of your next outpatient appointment, usually at 2 weeks for a wound check.
Arrange for a family member or friend to collect you. You must not drive after a general anaesthetic or sedation.
⚠️ Important: Joint replacement of the big toe is a motion-preserving procedure with a trade-off: slightly less reliable pain relief and higher revision rates than fusion. Discuss expectations carefully with your surgeon before opting for this approach.
Keep the foot elevated above the level of your heart for as much of the day as possible during the first 2 weeks. This significantly reduces swelling and helps healing.
Avoid getting the wound wet until it is fully healed, usually 10-14 days. Use a waterproof cover when showering.
Do not wait until pain is severe before taking medication. Regular simple analgesia (paracetamol, ibuprofen if appropriate) is more effective than taking it only when needed.
This is usually 2 weeks after surgery. Sutures or clips will be removed if used.
Seek urgent advice if you develop increasing redness, warmth, swelling, discharge from the wound, calf pain or swelling (possible DVT), shortness of breath, or a temperature above 38°C.
Foot kept elevated. Walking through the heel in a surgical shoe.
Stitches removed. Gentle toe motion exercises begin to maintain range.
Out of surgical shoe. Wide comfortable footwear. Physiotherapy continues.
Most patients return to walking comfortably with preserved toe motion. Long-term results assessed at 1 year.
Fusion is more durable and gives more reliable pain relief, at the cost of permanent stiffness. Replacement preserves motion, suited to those who specifically want to retain joint movement.
Possibly, replacement preserves more motion than fusion. However, high heels are not advised long-term as they put high stress on the implant.
Most implants function well for 10+ years, but revision rates are higher than for hip or knee replacement.
Desk work: 1-2 weeks. Standing work: 4-8 weeks. Manual work: 8-12 weeks.
Plain-English answers to the things people most often ask, grounded in published guidance. Tap a question to open it.
The arthritic big toe joint is resurfaced or replaced, or tissue is placed in the joint (interposition), to relieve pain while keeping some movement.
It is an alternative to fusing the joint.
Fusion is the most durable option for severe big toe arthritis. Replacement or interposition keeps some movement but is more selective and may need revision over time.
It is a trade-off between movement and long-term reliability.
Often a general or spinal anaesthetic with a foot block for pain relief.
Your anaesthetist will discuss the options.
Expect a post-operative shoe for some weeks and rehabilitation to regain movement. Swelling settles over months.
Following the movement programme helps the result.
Arrange a lift home and help in the first days, and plan time off.
Keep the foot elevated early on.
Spreading redness, discharge or a temperature can signal infection, and calf or chest symptoms can signal a clot.
Seek prompt help if these occur.