Cartiva: cushion for your big toe

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Most of us take our toes for granted, but if they stop working properly, they can have a widespread impact on our health.

For patients with arthritis of the big toe, surgery to fuse bones together often eliminates the pain but comes with some side effects.

Now, doctors are using a tiny shock absorber as a way to eliminate arthritis pain.

Fifty-nine-year-old Brian Bonsignore spent 25 years with the New York Fire Department. His last assignment was the most grueling of his career. He supervised what’s known as the GPS unit, recovering 9/11 victims and marking each location with a GPS tag.

“The government wanted to know where the body part or human remains were found,” Brian said.

The team spent eight months scouring the piles of rubble that remained at ground zero.

“It takes a toll on your knees, your legs, your joints. It takes a toll on every part of your body,” Brian said.

But it was the arthritis he developed in his big toe as a result that led Brian to Dr. Ettore Vulcano.

“Now, the gold standard for treating this condition has been, and still is, fusion,” Vulcano said.

Fusing the bones in his toe would eliminate pain, but also limit the range of motion. That’s why Brian opted for surgery to insert a cushion in between the toe bones. It’s called Cartiva.

“It’s a synthetic cartilage plug. It’s made of a material similar to that used for contact lenses,” Vulcano said.

Vulcano made an incision in the top of the toe, drilled a small hole in the joint, then slid the insert into place. The procedure took 30 minutes. Brian was up and moving in just a few days.

“Just enjoying my feet and walking around without any pain,” he said.

Vulcano says Cartiva is a good option for patients with end-stage arthritis in their big toes. If Cartiva doesn’t relieve the pain, fusion is still an option.

RESEARCH SUMMARY
CARTIVA: CUSHION FOR YOUR BIG TOE
REPORT #2608

BACKGROUND: If you have pain and stiffness in the big toe joint when you walk, stand, bend, or your big toe joint hurts in cold weather or swells, or you’ve ever noticed a bump on top of your foot, you may be suffering from hallux rigidus or early onset arthritis of your big toe. Hallux rigidus is a disorder of the joint located at the base of the big toe. It causes pain and stiffness in the joint, and with time it gets increasingly harder to bend the toe. This condition is a form of degenerative arthritis. Common causes of hallux rigidus are function and physical abnormalities of the foot that can lead to osteoarthritis in the big toe joint. This type of arthritis, the kind that results from wear and tear, often develops in people who have defects that change the way their foot and big toe function. For example, those with fallen arches or excessive pronation (rolling in) of the ankles are susceptible to developing hallux rigidus. In some people, hallux rigidus is genetic, while in others it is an overuse injury that results from repetitive trauma.
(Source: https://www.sentara.com/healthwellness/data/blogs/facts-about-big-toe-arthritis.aspx)

SYMPTOMS AND TREATMENT: Hallux rigidus is a progressive condition and the earlier it is diagnosed, the easier it is to treat. Therefore, the best time to see a foot and ankle specialist is when you first notice symptoms and hopefully before bone spurs develop. Most patients will improve with conservative therapy which can consist of physical therapy, injection therapy, medications and certain shoe gear modifications. In some cases, surgery is the only way to eliminate or reduce pain. Your foot and ankle specialist can discuss the various surgical options that exist based on your deformity. If surgery is needed, not only do patients go home the same day, they are often walking on the same day. If not treated early and effectively, arthritis of the big toe can lead to pain and disability in other parts of the body. As the pain worsens, patients will compensate by externally rotating the foot which can lead to premature knee and hip problems over time.
(Source: https://www.sentara.com/healthwellness/data/blogs/facts-about-big-toe-arthritis.aspx and https://southflaortho.com/cartiva-implant-surgery-testimonial/)

INNOVATIVE PROCEDURE: A new procedure for those suffering chronic big toe pain is, Cartiva. It has emerged as the most advanced treatment for toe arthritis available today. Before Cartiva, the go-to option for patient and surgeons to correct arthritis in the big toe joint was fusion surgery. Although effective in alleviating the pain, the procedure created a complete loss of mobility in the big toe. With Cartiva and its synthetic cartilage implant (SCI), patients regain full function of the foot with faster recovery times. Although previous implants have had mediocre results, the new Cartiva implant is inserted as part of a short process that favors quicker recovery, and preserves function of the big toe joint. It also allows for additional surgical treatment in the future to address any other difficulties.
(Source: https://southflaortho.com/cartiva-implant-surgery-testimonial/)