The patient is bothered by stiffness and pain in the joint with difficulty in bending the toe upwards. This in turn results in difficulty in walking, and the patient often walks on the outside of the foot.
The first treatment you should try is a rocker sole shoe or an MBT shoe – a built-up shoe that allows you to walk without bending the big toe. The patient gets a referral to the Orthopaedic Department. You can also treat the pain with anti-inflammatory tablets and sometimes try a cortisone injection in the joint.
If this treatment does not result in sufficient pain relief, then surgery can be discussed. However, the nerve can not be made completely normal again, as the operation focuses on increasing mobility and reducing pain. A common method is to cut off the top of the ball joint so that movement increases properly. In another method, the bone is sawn through, so that the joint has more play resulting in greater mobility. In both methods, you may put weight on the foot from the start and movement exercises begin after a few days. Sick leave is about 6 weeks. Neither method is probably better than the other.
Neither of these methods is good when the joint is completely worn out. Then an arthrodesis of the nerve may provide a good result. The big toe needs to be dressed with plaster of Paris for 6-8 weeks.
You can expect the pain to decrease or completely disappear after surgery and movement improves. However, the basic condition remains and the symptoms may return eventually. In the case of arthrodesis, movement in the main joint completely disappears, but a person can cope surprisingly well anyway. The joint condition is surgically removed and will not return.