Big toe joint replacement first for area

When people think about joint replacements, the big toe is not the first thing to come to mind.

However, a Minden podiatrist has performed possibly the first big toe joint replacement in the area.

Dr. Stefan Lorincz explained the procedure, arthroplasty, saying it is a long-term solution. There are several types of implants, such as plastic or silicone, but his preferred implant is a metal one. He says the body adjusts to the metal implant better than the plastic or silicone.

Dr. Stefan Lorincz, right, explains post operative care to Taja Manning, possibly the first patient to have a big toe joint replacement in the area. She holds her five and a half month old son, Jace. Michelle Bates/Press-Herald

“It is a replacement for the big toe joint,” Lorincz said. “Like hips and knee joints that you can replace, you can replace the toe joint if the joint is injured or if you have bad arthritis in the joint. We can put in a metal implant and still retain function and motion.”

The toe joint has two parts, and Lorincz replaced the top portion of the big toe joint in his patient, adding this is his first arthroplasty.

An X-ray of Taja Manning’s foot following a joint replacement in her big toe. Courtesy Photo/Minden Medical Center

“We used a hemi-implant, where half of the joint was replaced with a metallic implant,” he said. “These tend to last longer and there’s less reaction from the body to the metal.”
He says the decision to perform the procedure all depends on the patient and their needs.
“The primary indications are arthritis and pain,” he said. “This particular patient, she’s a younger patient, and we’d done a procedure to remove some extra bone around the joint, and when we did the procedure, I told her she had a lot of damage to the cartilage and the joint space is decreasing.”

He says age and activity level plays large factors in the decision to perform the surgery. Most physicians would recommend a fusion, where the toe joints are fused together. That limits movement, he says, although for those who are not very active, the fusion is a good choice.

If the issue had not been addressed, the pain she experienced with her toe would have eventually led to other issues such as back pain, hip or leg pain.

“With any part of the foot that hurts enough to make you either not walk or slow down, or change how you walk, that will give you pain in other joints,” he said. “Usually it starts in the foot, you’ll get tendonitis and Achilles heel and then it goes up the kinetic chain causing hip pain or lower back pain.”

Patient Taja Manning, 37, of Springhill, says she experienced pain and swelling in the joint from arthritis and could not wear regular shoes.

“I was constantly having pain and swelling,” she said. “I couldn’t hardly wear any shoes, no flip flops or anything without my foot swelling. I tried staying off of it and putting ice on it. I’m just trying to be able to wear different kinds of shoes, hopefully. With kids and sports, I was going all the time and I was hurting all the time.”

She says she is confident the surgery will take hold and she will be able to wear regular shoes again. She may not be able to wear high heels and boots but for short periods, but Lorincz says if Manning’s toe heals correctly, she should be able to return to her normal activities.

Manning has three children, two who play sports on a regular basis and a five and a half month old son she must care for. Her lifestyle is fairly active, and she walks a lot, Lorincz said.

“She’s kind of active; in the summer, she’s doing a lot of walking, wearing inappropriate shoes, like flip flops, and the joint started to bother her,” he said. “We came to a point where she wanted something done surgically, and she didn’t like the idea of a fusion. When you fuse a joint, usually you will end up with arthritis in other joints because you’re compensating for the lack of motion in that joint.”

Many of the patients who develop arthritis in their feet tend to be heavy into athletics, such as those who play high school sports, he said.

“We’ve seen it in high school students, even younger,” he said. “Dancing is a big one where the toe bends a lot, soccer, softball, anything with cleats are hard on that joint. In their early 20s, it’s going to be job related, jobs where you are required to be on the knee and bend your toes.”

He recommends comfortable shoes, ones that don’t aggravate the nerve that runs along the top of the foot. There are many different procedures that can be done to keep the joint mobile, he said, including cleaning it out and removing the extra bone, fusion or injections. However, the toe joint replacement is a last option, he says.