In many cases, damage to small parts of the body can be responsible for great pain. Such is the case with worn or damaged cartilage. This rubbery tissue acts as a cushion between the joints of the body and it has several functions, including holding bones together and supporting other tissues. It is critical to the joint’s flexibility and, as one astute observer noted, “it does not come with a lifetime warranty.” 

There are many joints in the foot and when the cartilage is damaged or worn down, intense pain can result. According to Dr. Christopher Sakowski, an orthopedic surgeon in the North Texas area and a member of the Texas Health Spine & Orthopedic Center referral line, the most common arthritis condition of the foot is arthritis of the big toe. When this occurs, the toe loses some of its cartilage, causing stiffness and pain.

Medical science has developed an innovative treatment for this worn or damaged cartilage of the big toe. According to a recent article on the subject, “A disarmingly simple solution, replacing the cartilage with a synthetic substitute, is rapidly coming into its own—with one product for big-toe arthritis already on the U.S. market, and alternatives for the thumb, knee, and shoulder either being tested in trials or being used by doctors in Europe.

“Doctors who have begun using such implants for patients say they can provide a faster recovery than traditional surgeries, and have other advantages—such as potentially delaying a full knee replacement or allowing the patient to retain motion of the big toe joint, handy for some sports and wearing high heels.”

Non-Surgical Treatment is the First Option

As a surgeon who treats foot and ankle conditions, Dr. Sakowski has a unique perspective on the challenges of dealing with damaged cartilage in the big toe.

“When arthritis or an injury causes a loss of cartilage in the big toe, this becomes very painful when the toe bends,” He said. “This can occur when a person is walking or doing other types of physical activities such as yoga poses.

“We always try a conservative approach as a first treatment option. There are shoe modifications, such as getting a shoe that is very stiff or getting a plate made of carbon fiber, called a ‘Morton’s Extension which goes under the big toe and keeps it from bending when the person is walking.

“If this approach does not work, an injection can be administered to the joint. However, with any injection, the relief is somewhat temporary. Over time, this can become less effective. This is when we begin discussing surgery with the patient.”

Surgical Treatment Includes a Synthetic Cartilage

“The ‘gold standard’ for treatment of worn or arthritic cartilage is a fusion of the two bones, removing the space between them,” Dr. Sakowski said. “This eliminates the motion between the bones and therefore the pain. While this results in alleviating the pain, some patients don’t want to lose the range of motion in their toe.

“The new procedure that has come along in the past two years is called the Cartiva implant. This procedure involves a ‘clean-out’ of the joint, to remove any damaged tissue and the insertion of a gum-dropped shaped insert. This synthetic cartilage acts as a partial joint replacement. According to some recent media coverage about this procedure, ‘To replace cartilage, a material must be strong enough to withstand forces on a joint, but soft enough so it doesn’t destroy surrounding tissue. The substitute material also must be porous and behave like a sponge—releasing fluids when it is pressed, and then recovering by reabsorbing them.’

“This Cartiva implant is a viable alternative to fusion of the joints,” Dr. Sakowski said, “Because it allows the person to keep motion in the joint while getting pain relief.”

Physicians who are members of the referral program practice independently and are not employees or agents of Texas Health Spine & Orthopedic Center.