The most basic and simple procedure to do from a surgical perspective is a cheilectomy. This is basically a joint cleaner procedure that it also involves aggressive removal of bone from the top of the first metatarsal. During this procedure, we also release soft tissue contracture of the capsule, especially on the bottom of the joint near the sesamoid bones. If there are big defects in the cartilage then any loose flaps of cartilage are removed and the exposed bone is drilled. The goal is to develop a fibrocartilage patch over the damage bone. If it's a larger section of damage bone and then a osteochondral or bone and cartilage graft can be taken from other joints and placed in the defect surgically. Another newer procedure is a joint implant called Cartiva. My partner, Dr. Nelson has discussed Cartiva joint implant procedures on our website. Another approach to this whole problem is to improve the mechanical function of the great toe and the first metatarsal.
This would involve realigning the entire first metatarsal to more functional position and essentially tilting it downward or dropping it. It is difficult to gain significant improvement in the alignment by doing a procedure at the head of the first metatarsal. However the first metatarsal cuneiform joint that often has hypermobility and elevation of the entire metatarsal is a great joint to utilize to improve function of the entire foot and the first metatarsal phalangeal joint. This is a midfoot fusion also known as a Lapidus procedure.
The first metatarsal is plantar flexed and the fusion was done at the joint and augmented with bone graft material and hardware or screws or plates are used to maintain the alignment until the bone fusion is complete. Another fusion would be for severe cases arthritis in the great toe joint where the entire joint itself is fused. This is another very effective procedure and totally eliminates any joint pain here. The downside is that there is no motion whatsoever at the big toe joint. It is surprising how well people function after this is done. If you have questions about some of these treatment options please let us know. Both Dr. Nelson and myself–Dr. Young, have extensive experience treating these problems.
If you are experiencing any foot or heel pain, do not hesitate to call us at 425-391-8666 or contact us online.