Big Toe Arthritis: Great Toe Joint Fusion With a Plate and Screws

Big Toe Arthritis: Great Toe Joint Fusion With a Plate and Screws

This video is a cadaveric demonstration of a big toe fusion for the treatment of big toe arthritis. Here, we have a left foot. The surgeon begins by making an incision along the top of the big toe and bends the big toe to expose the big toe joint.

The surgeon uses a reamer to drill a small tunnel into the foot bone and remove the cartilage from the joint surface. The same steps are repeated for the toe bone. The big toe joint is then straightened, and a small metal pin is inserted across the joint to maintain the alignment of the big toe. The surgeon will check the alignment by making sure that the end of the big toe can still move.

Next, the surgeon places a metal plate on top of the bones of the big toe joint. The black line on the metal plate is aligned directly over where the bones meet. The surgeon then inserts two ball-headed pins into the bones to temporarily hold the metal plate in place. The surgeon uses a drill to create a hole into the toe bone and inserts a screw to attach the metal plate to the bone. The surgeon repeats this step two more times to insert two more screws to hold the metal plate in place.

At this time, one of the ball-headed pins will be removed. The surgeon next drills a hole into the foot bone. The second ball-headed pin is removed, and a compression tool is inserted into the socket. The surgeon turns the compression tool clockwise to compress the foot bone and toe bone together. Once the new alignment is achieved, the ball-headed pin is reinserted through the metal plate to maintain the compressed position of the big toe joint.

The surgeon then uses the drill to create another hole into the foot bone and inserts a screw to attach the metal plate to the bone. The ball-headed pin is then removed, and the screw is inserted further to apply more compression. The surgeon inserts two more screws into the foot bone to hold the metal plate in place. After the plate is secured, the small metal pin is removed, and a screw is inserted across the two bones to further compress and stabilize the toe joint. The skin incision is closed with sutures, and the procedure is complete.