Great Toe Arthritis
Hallux Rigidus (Great Toe Arthritis) Treatment at The London Podiatry Centre
Arthritis of the big toe joint (hallux rigidus) is a common condition that can cause stiffness, pain, and difficulty walking. At The London Podiatry Centre, we start with a detailed biomechanical assessment and imaging to identify the severity of the arthritis and the underlying cause.
Many cases can be managed without surgery, using specialist footwear, custom orthoses, and targeted injections to reduce stress and inflammation in the joint. However, when conservative care is not successful, Mr. Ron McCulloch offers a full range of surgical treatments.
Unlike many UK clinics, we avoid routine joint fusion (arthrodesis), as it can disrupt natural foot mechanics. Instead, we aim to preserve joint motion wherever possible. If the joint is salvageable, we perform a cheilectomy to remove excess bone and restore mobility.
When arthritis is more advanced, Mr. McCulloch’s preferred option is interpositional arthroplasty — a highly specialist technique where a biological spacer is created using the patient’s own joint capsule tissue. This preserves joint function without the need for implants.
Mr. McCulloch learned this technique directly from Dr. E. Dalton McGlamry, one of the most influential figures in podiatric surgery and founder of the renowned Podiatry Institute in Atlanta. Dr. McGlamry was a pioneer in foot and ankle surgery and authored the field’s leading textbook, McGlamry’s Comprehensive Foot and Ankle Surgery. Training under Dr. McGlamry has enabled Mr. McCulloch to bring these advanced surgical options to the UK.
For more information about treatment options, including interpositional arthroplasty, please contact The London Podiatry Centre.
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Why Hallux Rigidus Is So Complex
Over the years, many types of artificial great toe joint implants have been developed, but few have stood the test of time. While there is often initial excitement with new implant designs, long-term outcomes frequently reveal disappointing results, with implant failures sometimes only becoming fully apparent years after widespread use.
When the arthritis is mild and limited to the top of the joint, a cheilectomy can be performed — this involves removing excessive bone spurs to improve joint motion and reduce pain. However, when the joint becomes significantly arthritic, the most common surgical approach performed in the UK is fusion (arthrodesis).
The Problem With Great Toe Joint Fusion
Although fusion can eliminate pain within the joint itself, it permanently locks the great toe and removes a critically important joint from the walking cycle. This loss of motion significantly alters gait mechanics. While some surgeons attempt to mitigate these effects through specialised footwear, rocker-bottom shoes, or other adaptations, The London Podiatry Centre believes that fusion often leads to profound long-term biomechanical consequences, increasing the risk of developing additional musculoskeletal problems in the foot, ankle, knee, hip, and spine.
This reality is clearly demonstrated through the in-depth computerised gait analysis routinely performed at our Centre. Gait data consistently shows abnormal loading patterns and compensations in patients who have undergone fusion of the great toe joint.
What Is the Solution?
Given the limitations of both fusion and artificial joint implants, The London Podiatry Centre offers a highly specialised surgical technique for selected patients with hallux rigidus:
Interpositional Arthroplasty
This procedure was originally taught to Mr. McCulloch by the world-renowned American foot surgeon Mr. Dalton McGlamry, a historic figure in foot surgery. Over the years, Mr. McCulloch has refined and perfected this technique based on extensive clinical experience.
In interpositional arthroplasty, damaged joint surfaces are carefully debrided, and part of the patient's own joint capsule (a natural soft tissue layer) is sewn into the joint space to preserve motion while relieving pain. This approach:
- Avoids the risks associated with artificial joint implants.
- Maintains important joint mobility for a more natural walking pattern.
- Can still be revised to a fusion later if necessary — making it a safe and reversible first surgical option.
- Provides patients with the potential for significantly better long-term gait function compared to fusion.
Why Choose The London Podiatry Centre for Hallux Rigidus Treatment?
- Highly specialised centre with international experience in complex great toe arthritis.
- Access to advanced gait analysis and biomechanical evaluation to guide treatment.
- Surgical expertise refined over decades of experience.
- Interpositional arthroplasty offered as a highly specialised alternative to fusion.
- Comprehensive long-term care with a focus on preserving function and quality of life.
If you are suffering with great toe joint arthritis, The London Podiatry Centre offers one of the most advanced and specialist services available in the UK. Contact us today to arrange a consultation and explore your treatment options.
