“My Feet Are Killing Me!”: New Options for Foot and Ankle Pain Relief

Walking: It’s something you take for granted — unless it’s painful to put one foot in front of the other. The pain may be due to foot and ankle arthritis, which causes the cartilage to break down. Orthopaedic surgeon Sara Lyn Miniaci-Coxhead, MD, shares the latest procedures that can give you relief.

Synthetic cartilage implant: an effective treatment for big toe arthritis

An approach that uses a contact lens-type material is growing in popularity. It replaces the body’s natural cartilage (cushioning material) that wore away because of good ol’ wear and tear.

“If someone is suffering from pain in the great toe, we can use a gumdrop-shaped implant made from a material similar to contact lenses,” says Dr. Miniaci-Coxhead.

During the procedure, which lasts about 15 minutes, your surgeon will:

1. Drill out a section of the metatarsal bone that’s just behind the big toe.
2. Pop in the gumdrop implant to serve as a cushion between the big toe and the adjacent toe.
3. Close the incision and send you on your way (though you might not see full results for up to six months)

Is cartilage replacement in the big toe right for you?

“If an implant isn’t going to work, you’ll likely know within the first two years,” says Dr. Miniaci-Coxhead. “People who make it to five years have a 92% success rate. For most patients, success means pain relief.”

The alternative to replacement is a fusion procedure, where surgeons permanently connect the big toe to the adjacent bone. Fusion is the gold standard and has a 95% success rate.

So why choose cartilage replacement?

• Range of motion: Many people worry about movement, but they shouldn’t – you can typically be as active on a fusion as you want to be. An implant helps you retain your range of motion.
• A good first try: If an implant isn’t working for you, your surgeon can easily convert it to a great toe fusion.

“You have to be the right candidate for an implant,” says Dr. Miniaci-Coxhead. “If you have a bunion or another reason for pain around the big toe joint, a toe joint fusion might be a better choice.”

Ankle replacements: an option for arthritis-related ankle pain

Arthritis in the ankle joint is another condition that’s a real pain in the feet. And ankle joint replacement procedures are gaining in popularity.

“The first generation of replacement ankle joints, designed in the 1970s, was less successful,” says Dr. Miniaci-Coxhead. “But the device is now in its third generation, and we’re seeing a real improvement for patients.”

During an ankle replacement surgery, your surgeon will:

1. Makean incisionto access your ankle joint.
2. Remove damaged cartilage and bones.
3. Place an artificial joint between the ankle bones, so the bones easily glide against each other.

Total ankle replacement vs. ankle fusion

People find ankle replacement alleviates their pain in 80 to 90% of cases. The alternative, ankle fusion (permanently connecting the bones at the point where the cartilage has worn away), has a similar success rate.

With similar pain-relieving results, how do you choose between ankle fusion and ankle replacement? If maintaining your range of motion is important to you, then the ankle replacement is the best bet.

But don’t count on an ankle replacement if you have any form of neuropathy — nerve damage in the feet. In that case, a fusion will give you the best result.

“Talk to an orthopaedic surgeon if you have pain or difficulty walking,” says Dr. Miniaci-Coxhead. “Your surgeon can guide you to the best option for relief. There is always something we can do!”