Degenerative joint disease of the great toe joint has been called by many names: Hallux Rigidus, severe Hallux Limitus, late or end stage arthrosis, Hallux Flexus, dorsal bunion, arthritis of the big toe, Gout, enchondrosis, chondro-malacia. No matter what it has been called throughout history, one thing is certain. Persons with it experience severe pain and disability. Henry the VIII’s suffering was legendary.

Degenerative joint disease (DJD) of the great toe joint (1^st metatarsophalangeal joint) was described as early as 1887, by Davies-Colley of Guy’s Hospital. He had been unable to find any description in surgical writing and thus described the symptoms himself. One year later, J.M. Cotterill redescribed the condition and named it Hallux Rigidus.
 

DJD of the great toe joint or Hallux Rigidus is essentially osteoarthritis or wear and tear arthritis. It is recognized by pain and loss of motion in the great toe joint. There may be swelling and enlargement of the joint, inflammation and the inability to propel. Xrays may reveal a loss of joint space and deformity of bone. This disease/deformity may be caused by trauma, metabolic illness or mechanical fault of the foot. Surgical repair can be varied and often times employs a procedure that is close to 90 years old. Historically, these procedures resulted in reduction of pain, instability or stability with loss of motion, but always with dysfunction. Therefore as early as 1962, dedicated foot surgeons wrestled with designing implantable prostheses, to improve the results of these surgical procedures. Initially, great toe joint implants were metallic and simulated the natural contours of the joint. Most attempts at surgical improvement resulted in dislodgement of the implants and bone loss due to absorption.

The longest record of success belonged to the silicone rubber (silastic) implants that more resembled hinges than normal anatomical contours. Implants of this family are considered inter-positional devises and were actually modifications of finger implants.  A closer look at the results of this generation of implants, revealed abnormal bone reactions more serious than previously reported. In the mid to late 1980’s, they too fell into disfavor.

In 1988, benefiting from technological advancements in materials, design and lessons learned from hip and knee replacements, Koenig revived the concept of total joint replacement. Over the next 4 years, changes in materials, instrumentation and the addition of osseo-conductive coatings improved the Total Toe System to make it the most advanced and enduring great toe joint replacement available in the world of medicine and surgery. Three scientific treatises have been published in the Journal of Foot and Ankle Surgery concerning the results of the Total Toe System over the past 10 years; the most published joint implant of its kind.

Modern medicine and surgery is pledged to move forward cautiously. Surgery of the Great Toe Joint is no exception. The goal of this surgery should be the relieve of pain and suffering with joint stability and the return of function wherever possible. Our active population deserves to know of advancement and improvement.