You want to fuse my big toe joint?!!

Many patients come to my office with pain in their big toe joint that increases with activity and can get very painful and limiting.  When evaluating the patient clinically and on X-ray, I determine if they have end-stage arthritis of the 1st metatarsal phalangeal joint, or the big toe joint.  There are many forms of nonsurgical and surgical treatment for arthritis in the big toe joint depending on how advanced the arthritis is.  However, for the end-stage arthritis patient who has complete erosion of the cartilage in their joint, surgical arthrodesis or fusion of that joint is the "gold standard" of treatment.

Most patients however don't want to hear that their joint needs to be fused in order to be pain-free and to return to activity.  That's a natural thought and concern.  However, what is important to consider is that patients with end-stage arthritis already have drastically limited to no motion in their joints as it is.  If they come into my office with "bone on bone" arthritis, then a surgical fusion is taking a joint that already doesn't move but is painful to a joint that doesn't move but is pain-free.  The goal of the surgery is to allow you to be just as functional as you want to be but without pain.

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