The Center for Podiatric Care and Sports Medicine

The Metallic Hemi-Great Toe Implant Debate: Options for Advanced Hallux Rigidus Surgery

Posted by on Monday, February 11th, 2013


Hallux rigidus surgery has made great strides over the past few decades (so to speak). Today there are a few popular options for hallux rigidus surgery, some of which we explored in yesterday’s post. And it’s a good thing: Hallux rigidus, like many foot and ankle ailments (and like snowflakes) is slightly different in each patient. While one arthritic toe may respond to the removal of bone spurs and nothing else (cheilectomy) others will require more dramatic treatment. There have been many advances in implant technologies, all with certain goals in mind: mobility of the big toe (MTP) joint, painlessness, and maintenance over several years. Implants are typically used in stage III and IV cases, when mobility is dramatically decreased and the patient is in pain that keeps him from participating in everyday activities.



Recently our own Dr. Geldwert reviewed research on the subject of the hemi-great toe implant—an implant commonly used to treat this condition. His conclusion: a double-stemmed, hinged artificial joint is better. But I’m going to teach the controversy. (If you’d like to review the article yourself, see Results of Metallic Hemi-Great Toe Implant for Grade III and Early Grade IV Hallux Rigidus. Foot and Ankle Quarterly, Spring 2013.)

To orient you a little: the uncemented porous coated Futura Hemi-Great Toe Implant may sound like a futuristic torture device, and I suppose it could be one in the wrong hands, but it’s also a promising treatment for hallux rigidus. In this particular study the researchers reported excellent results: no postoperative complications, a full recovery in 4 months, dramatically improved range of motion, with most patients reporting no pain. Their conclusion: “Most patients with grade III or early grade IV hallux rigidus can expect good or excellent results following surgical treatment with the Futural Hemi-Great Toe Implant.” But hold your horses, true believers. That’s not the whole story.




In his commentary on the study, Dr. Geldwert questioned the study’s results. First, this was a very small sample size (only 23 patients). The small sample size alone is of concern, since population-wide results may vary greatly from those of a few individuals. Additionally, Dr. Geldwert’s own experience does not reflect the study’s findings. In his experience with the implant over the past 39 years he has found that it is good at relieving pain but that range of motion is rarely adequate (though, interestingly, it is the lack of range of motion that results in lack of pain). This is particularly worrisome for active patients who hope to return to athletic activity after surgery.



Instead, Dr. Geldwert recommends the double-stemmed hinged total first MTP joint implant. After hundreds of procedures, he has seen predictable, positive results. This implant effectively increases range of motion and reduces pain.


If you have any foot problems or pain, contact The Center for Podiatric Care and Sports MedicineDr. Josef J. GeldwertDr. Katherine Lai, Dr. Ryan Minara and Dr. Mariola Rivera have helped thousands of people get back on their feet. Unfortunately, we cannot give diagnoses or treatment advice online. Please make an appointment to see us if you live in the NY metropolitan area or seek out a podiatrist in your area.