New Treatment for Big Toe Arthritis

Dr. Christopher Sakowski is an orthopedic surgeon specializing in the diagnosis and treatment of conditions affecting the foot and ankle. He joined the medical staff of Texas Health Center for Diagnostics & Surgery in Plano in 2017 and has quickly made a name for himself using a new technique to treat big toe arthritis.

Most people associate osteoarthritis (OA) with pain in the hands, hips and knees, but big toe arthritis is a common form of OA that results in tenderness and achiness when cartilage at the base of the big toe begins to degrade, typically at age 35 or later. Over time the toe can become stiff and difficult to bend, a condition called Hallux Rigidus, severely limiting physical activity.

Surgical Options

“Until recently, there were two primary surgical options to treat big toe arthritis,” said Dr. Sakowski. “The first option is to perform a general “cleanout” of the joint to create space and allow it to move more freely.  This procedure is less invasive but not permanent, as the joint is susceptible to further decline.

“The other more permanent option is fusion, in which the damaged cartilage is removed and the joint is fixed in a permanent position using a plate and screws. Fusion provides long term pain relief but severely limits the ability of the toe to move, which has other implications, such as preventing women from wearing certain types of high heeled shoes.”

Over the past few years, an exciting new treatment option for big toe arthritis has emerged–the Cartiva procedure. Cartiva delivers the pain relief of fusion but enables patients to retain, and even improve, their range of motion.  “Cartiva is a wonderful development in that it gets patients back to doing what they did before with less limitation in their range of motion.  It also significantly shortens recovery times, with patients able to bear weight on their foot almost immediately, versus six weeks with fusion.”

What is the Cartiva Procedure?

So what is the Cartiva procedure? According to Dr. Sakowski, it is sort of a hybrid cleanout procedure in which the doctor first removes the damaged cartilage and then drills out a small amount of bone surface at the joint.  Rather than permanently fuse the joint, however, a small, gumdrop shaped piece of material is inserted into the hollowed out space, thus providing a smooth, slippery surface that functions similarly to natural cartilage.  While the surgery is performed under general anesthesia, it is relatively short, typically taking just 25 to 30 minutes.

“The Cartiva procedure only received final FDA approval for use in the U.S. in mid-2016, but five-year trial studies, as well as experience with the surgery in other countries, show exciting potential long term,” said Dr. Sakowski. “In the five-year studies, more than 95 percent of patients were still functioning well with Cartiva five years post-surgery.  And, the material used in the procedure, a biocompatible, durable, slippery organic polymer, is showing great longevity, so it appears the benefits will continue.  Finally, if for some reason Cartiva does not last permanently, patients can still undergo traditional fusion, thus it does not limit any future treatment options.”

Dr. Sakowski sums up his thoughts about the impact Cartiva is having…on patients and him personally. “Doctors practice medicine because we find great satisfaction in relieving pain and suffering.  Getting to do so with a new, leading edge procedure that didn’t exist just a few short years ago is extra gratifying.  I’m excited about how Cartiva has advanced the treatment for big toe arthritis and look forward to treating more and more patients for it at Texas Health Center for Diagnostics & Surgery.”

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